Clinical application of 3D ASL in the evaluation of cerebral watershed perfusion in patients with different degrees of carotid stenosis
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摘要:
目的探讨三维动脉自旋标记（3D ASL）技术在评估不同程度颈动脉狭窄后大脑分水岭灌注状态方面的临床应用价值。 方法收集2018年1月~2020年3月于脑病科初诊为缺血性脑血管病患者60例，经颈部彩色多普勒超声分别评估双侧颈动脉狭窄度。同时行3D ASL成像检查，使用Functool软件将原始数据自动生成脑血流量（CBF）伪彩图，分别于皮质分水岭前角及后角、放射冠及半卵圆中心选取兴趣区（ROI=200±20 mm2），测量并分析不同程度颈动脉狭窄患者大脑分水岭区CBF值差异。 结果共采集颈动脉120根，其中颈动脉无狭窄30根，轻度狭窄49根，中度狭窄26根，重度狭窄15根，颈动脉轻度狭窄患者皮质分水岭前、后角CBF值与颈动脉无狭窄患者差异无统计学意义（P > 0.05），内分水岭区CBF值低于无狭窄患者，差异有统计学意义（P < 0.05）；颈动脉中度、重度狭窄患者皮质分水岭及内分水岭CBF值均明显低于无狭窄患者，差异有统计学意义（P < 0.05）。 结论3D ASL成像技术可敏感评估不同程度颈动脉狭窄患者大脑分水岭区脑灌注状态，对于患者治疗方案的选择以及预后评估具有重要应用价值。 Abstract:ObjectiveTo investigate the clinical value of 3D ASL in assessing the perfusion status of cerebral watershed after different degrees of carotid stenosis. MethodsSixty patients with ischemic cerebrovascular disease who were initially diagnosed in the Department of encephalopathy from January 2018 to March 2020 were collected. The degree of bilateral carotid artery stenosis was evaluated by CDFI. Meanwhile, 3D ASL imaging was performed, and the original data were automatically generated into a pseudo color map of cerebral blood flow (CBF) using functool software, and three-dimensional arterial spin labeling (3D ASL) imaging examination. The interest areas (ROI=200±20 mm2) were selected from the front and back corners of the cortical watershed, the radial crown and the center of the semicircular circle. The CBF values of the cerebral watershed in patients with different degrees of carotid stenosis were measured and analyzed. ResultsThere were 120 cases of carotid artery, 30 cases of no stenosis, 49 cases of mild stenosis, 26 cases of moderate stenosis, 15 cases of severe stenosis. There was no significant difference in CBF between the patients with mild stenosis and the patients without stenosis (P > 0.05). The CBF value in the inner watershed was lower than that in the patients without stenosis (P < 0.05), The CBF values of cortical watershed and internal watershed in patients with moderate and severe carotid stenosis were significantly lower than those in patients without stenosis (P < 0.05). Conclusion3D ASL imaging technology can sensitively evaluate the cerebral perfusion in the watershed area of patients with different degrees of carotid stenosis. It has important application value for the selection of treatment plan and prognosis evaluation of patients. -
Key words:
- carotid artery /
- hemodynamics /
- arterial spin labeling /
- cerebral blood flow
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图 1 患者男，56岁，右肢活动不利1年余
A~D: 颈部CDFI提示左侧颈内动脉起始部重度狭窄（狭窄率77%），右侧颈总动脉分叉处轻度狭窄; E~J: 3DASL（PLD=1525 ms）提示左侧皮质分水岭及内分水岭区CBF值明显低于右侧.
Figure 1. A56-year-old Male patient, right limb movement is not good for more than one year.
表 1 不同程度颈动脉狭窄后分水岭区CBF值比较
Table 1. Comparison of CBF values in watershed area after different degrees of carotid stenosis[mL/(min·100 g), Mean±SD]
颈动脉狭窄程度 皮质分水岭 内分水岭 前角 后角 放射冠 半卵圆中心 无狭窄（n=30） 54.25±4.57 53.34±4.65 37.55±4.87 36.86±4.81 轻度狭窄（n=49） 53.12±4.61 52.78±4.82 32.64±4.83 32.83±4.78 中度狭窄（n=26） 43.64±5.42 42.17±5.26 23.87±5.81 24.21±5.77 重度狭窄（n=15） 28.58±5.86 27.35±6.08 20.51±5.43 19.85±5.24 
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