MRI电影相位对比法在外伤后颅脑血流动力学异常的临床诊治中的应用

目的研究磁共振电影相位对比法在外伤后脑血流动力学异常临床诊治中的价值。方法选取75例脑外伤后经临床颅内压测量并结合颅脑磁共振静脉窦成像综合分析确诊颅脑血流动力学异常患者(颅内压升高代偿期32例;失代偿期43例),应用磁共振电影相位对比法监测小剂量尿激酶治疗前后颈内静脉血流动力学指标的变化。结果 32例代偿期脑外伤患者左、右侧颈内静脉出颅段平均流速及平均流量为21.78(12.12～41.31)cm/s,26.52(11.44～43.69)cm/s;0.90(0.40～1.34)L/min.cm2,1.00(0.52～1.32)L/min.cm2;流速快于健康志愿者(P﹤0.05)。43例失代偿期脑外伤患者左、右侧颈内静脉出颅段平均流速及平均流量为14.36(10.21～16.56)cm/s,13.56(10.23～16.53)cm/s;0.52(0.20～1.01)L/min.cm2,0.49(0.23～0.93)L/min.cm2;流速及流量均小于健康志愿者(P﹤0.05)。行小剂量尿激酶干预后2～3天内,32例代偿期患者颅内压降至100～190mmH2O,左、右侧颈内静脉出颅段平均流速均较治疗前减慢(P﹤0.05)。43例失代偿期患者颅内压降至170～220mmH2O,左、右侧颈内静脉出颅段平均流速均快于治疗前(P﹤0.05)。结论磁共振电影相位对比法能无创性动态监测颅脑外伤患者颅脑血流动力学变化,指导临床干预治疗,从而降低外伤性颅内静脉窦血栓形成的发生率。

Application of phase contrast cine MRI in diagnosis and treatment of traumatic brain hemodynamic abnormalities

Objective To investigate the value of phase contrast cine magnetic resonance(MR) imaging in the diagnosis and treatment of traumatic brain hemodynamic abnormalities.Methods The MRI data of 75 patients with brain hemodynamic abnormalities secondary to traumatic brain injury were retrospectively studied.The hemodynamics changes of internal carotid vein before and after treatment with small doses of urokinase were monitored with phase-contrast cine MRI.Results In 32 cases at compensatory stage,the average velocity of left and right internal carotid vein were 21.78(12.12~41.31) cm/s,26.52(11.44~43.69) cm/s and were faster than that in the healthy population(P﹤0.05).In 43 cases at decompensation stage,the average velocity and flow of internal carotid vein were lower than the healthy population(P﹤0.05).After 2 or 3-day treatment with small doses of urokinase,the average velocity of internal carotid vein at compensatory stage were lower than those before treatment(P﹤0.05).In 43 cases at decompensation stage,the average velocity of internal carotid vein out cranial section were faster than those before treatment(P<0.05).Conclusion MRI 2D-PC Cine can be used to noninvasively monitor of patients with hemodynamic changes secondary to traumatic brain injury brain,thereby guiding clinical intervention,and reduceing the incidence of traumatic intracranial venous sinus thrombosis.