MR多模态对慢性大脑中动脉闭塞侧支循环的临床研究价值

目的探讨MR多模态的磁共振血管成像(MRA)、液体衰减反转恢复成像序列(FLAIR)和三维的伪连续式动脉自旋标记技术(three dimensional pseudo continuous arterial spin labeling,3D-PCASL)对慢性大脑中动脉闭塞(chronic middle cerebral artery occlusion,CMCAO)诊断价值研究。方法47例CMCAO患者行常规MRI、MRA及3D-PCASL检查,利用MRA、FLAIR与3D-PCASL联合应用对CMCAO的MRA侧支循环分级与远端高信号血管征(hyperintense vessel sign,HVS)和脑血流量(cerebral blood flow,CBF)进行相关性分析及预后研究。结果在47例CMCAO患者中0级5例,1级22例,2级16例,3级4例,侧支循环良好组20例,占42.6%,不良组27例,占57.4%;良好组远端HVS的侧支循环阳性3例、占6.4%,阴性17例、占36.2%,不良组阳性22例、占46.8%,阴性5例、占10.6%;良好组高等灌注19例,占40.4%,低灌注1例,占2%,不良组中高等灌注2例,占4.3%,低灌注25例,占53.2%。47例CMCAO复查患者有24例,进展期14例中不良组13例,占54.1%(13/24),良好组1例、占4.2%。未见进展期10例中不良组2例,占8.4%,良好组8例、占33.3%。经卡方检验,MRA侧支循环各分级间的远端HVS阳性率和CBF均有不同,差异有统计学意义(χ²=21.29,P<0.01和χ²=37.56,P<0.01)。结论MRA、远端HVS和3D-PCASL能够反映CMCAO侧支血管形态学及血流动力学改变,MRA侧支循环分级越高,远端HVS阳性率越低,脑灌注情况越好,患者预后好,反之,患者慢性缺血将进一步加重,需要临床积极干预,防止急性缺血性脑卒中发生,同时三者联合应用可以较准确判断CMCA0早期诊断及慢性缺血变化和预后情况,为临床判定CMCAO患者是否存在侧支循环代偿和治疗方案提供依据。

The clinical value of magnetic resonance multimodality in the treatment of chronic middle cerebral artery occlusion with collateral circulation

Objective To investigate the diagnostic value of MRA,FLAIR and 3D pseudo continuous arterial spin labeling(3D-PCASL)for chronic middle cerebral artery occlusion(CMCAO).Methods Forty-seven patients with CMCAO underwent routine MRI,MRA and 3D-PCASL examination.MRA,FLAIR and 3d-pcasl were combined to analyze the correlation between CMCAO MRA collateral circulation grading and cerebral blood flow(CBF)of hyperintense vessel sign(HVS)and 3D-PCASL.Results Among the 47 patients with CMCAO,there were 5 patients with grade 0,22 patients with grade 1,16 patients with grade 2,and 4 patients with grade 3.In the good group,positive collateral circulation was found in 3 cases(6.4%),negative in 17 cases(36.2%),negative in 22 cases(46.8%),and negative in 5 cases(10.6%).There were 19 cases of advanced perfusion(40.4%)in the good group,1 case of low perfusion(2%),2 cases of advanced perfusion(4.3%)in the bad group,and 25 cases of low perfusion(53.2%).There were 24 patients with CMCAO reexamination in 47 patients,and among the 14 patients with progressive stage,13 were in the adverse group,accounting for 54.1%(13/24),and 1 was in the good group,accounting for 4.2%.Among the 10 cases with no progression,2 cases were in the adverse group,accounting for 8.4%,and 8 cases were in the good group,accounting for 33.3%.The chi-square test showed that there were differences in the distal HVS positive rate and CBF among the grades of MRA collateral circulation,with statistically significant differences(χ²=21.29,P<0.01 andχ²=37.56,P<0.01).Conclusion MRA,distal HVS and 3 D-PCASL reflect CMCAO collateral vessels,morphological and hemodynamic changes MRA grade.The higher the collateral circulation,the louer the distal distal HVS positive rate is the betted cerebral perfusion,the better the prognosis is.On the contrary,will increase further,patients with chronic ischemia need clinical intervention,prevention of acute ischemic stroke.At the same time,the combined application can accurately determine CMCA0 chronic ischemia change and prognosis,early diagnosis and for patients with clinical judgement CMCAO whether there is a compensatory collateral circulation and provide basis for treatment.