刘颖,徐慧敏,霍然,王筝,王涛,袁慧书.三维伪连续及血管选择性动脉自旋标记技术预测颈动脉内膜切除术后脑过度灌注[J].中国医学影像技术,2021,37(7):984~988
三维伪连续及血管选择性动脉自旋标记技术预测颈动脉内膜切除术后脑过度灌注
Prediction of cerebral hyperperfusion after carotidendarterectomy with three dimensional-pseudocontinuous andterritorial arterial spin labeling
投稿时间:2020-07-16  修订日期:2021-04-22
DOI:10.13929/j.issn.1003-3289.2021.07.005
中文关键词:  内膜切除术,颈动脉  脑血管循环  侧支循环  过度灌注  动脉自旋标记
英文关键词:carotid  cerebrovascular circulation  collateral circulation  hyperperfusion  arterial spin labeling
基金项目:北京市自然科学基金(7192219)。
作者单位E-mail
刘颖 北京大学第三医院放射科, 北京 100191  
徐慧敏 北京大学第三医院放射科, 北京 100191  
霍然 北京大学第三医院放射科, 北京 100191  
王筝 北京大学第三医院放射科, 北京 100191  
王涛 北京大学第三医院神经外科, 北京 100191  
袁慧书 北京大学第三医院放射科, 北京 100191 huishuy@bjmu.edu.cn 
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中文摘要:
      目的 评价三维伪连续动脉自旋标记(3D-pcASL)及血管选择性动脉自旋标记(tASL)技术预测颈动脉内膜切除术(CEA)后脑过度灌注的价值。方法 纳入29例CEA后颈总动脉及颈内动脉(ICA)起始段重度狭窄患者,采用3D-pcASL和tASL技术测量手术前后大脑中动脉供血区脑血流量(CBF)及各供血区灌注体积(PV),计算总灌注体积(PV)及术侧CBF差值比(DRCBF);比较手术前、后PV双侧ICA、PV及CBF术侧的差异。根据DRCBF将患者分为过度灌注组(n=6)及无过度灌注组(n=23),比较术前PV双侧ICA、PV和CBF术侧差异。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价术前CBF术侧、PV预测术后发生过度灌注的效能。结果 CEA术前,过度灌注组CBF术侧明显低于无过度灌注组,PV明显小于无过度灌注组(P均<0.05);术后CBF术侧较术前增加,PV术侧ICA升高,PV对侧ICA下降(P均<0.05)。根据术前CBF术侧及PV预测术后发生过度灌注的AUC分别为0.942及0.790。结论 3D-pcASL及tASL可用于无创获得脑血流灌注并直观观察、测量侧支循环情况;术前CBF及PV预测CEA术后发生过度灌注的效能较高。
英文摘要:
      Objective To observe the value of three dimensional-pseudocontinuous arterial spin labeling (3D-pcASL) and territorial arterial spin labeling (tASL) for prediction of cerebral hyperperfusion after carotid endarterectomy (CEA). Methods A total of 29 patients with severe stenosis of common carotid and internal carotid artery (ICA) who underwent CEA were enrolled. The cerebral blood flow (CBF) of the middle cerebral artery and perfusion volume (PV) of each arterial blood supply area were measured with 3D-pcASL and tASL before and after CEA. Te total PV (PVtotal) and difference ratio of CBF (DRCBF) on the affected side were calculated. PV of bilateral ICA, PVtotal and the CBFoperation were compared before and after CEA. The patients were divided into hyperperfusion group (n=6) and non-hyperperfusion group (n=23) according to the DRCBF. PV of bilateral ICA, PVtotal and CBFoperation were compared between groups. Receiver operating characteristic (ROC) curves were drawn, and the areas under the curves (AUC) were calculated to evaluate the efficacy of preoperative CBFoperation and PVtotal for predicting the occurrence of postoperative hyperperfusion. Results Before CEA, CBFoperation and PVtotal of hyperperfusion group were significantly lower than those of non-hyperperfusion group (all P<0.05). After CEA, CBFoperation and PV of operative ICA increased, and PV of ICA on the contralateral side decreased than before (all P<0.05). AUC of the preoperative CBFoperation and PVtotal for predicting the occurrence of hyperperfusion was 0.942 and 0.790, respectively. Conclusion 3D-pcASL and tASL could be used to non-invasively display CBF perfusion, directly observe and measure the collateral circulation. Preoperative CBF and PVtotal had relative high effect for predicting the occurrence of hyperperfusion after CEA. endarterectomy,
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