灌注核磁共振技术对颈动脉系统狭窄或闭塞的血流动力学和外科疗效的评价

目的 利用灌注磁共振技术分析颈动脉系统狭窄或闭塞时血流动力学特点,并以此评价外科治疗疗效。方法 21例接受外科治疗的颈动脉狭窄或闭塞患者中,行颈内动脉内膜切除者2例,行颅内外血管吻合者10例,行支架血管成形术者9例。结果 21例患者术前局部脑血流量正常,但大脑中动脉分布区及分水岭区的灌注明显延迟;术后分水岭区的灌注恢复正常,与术前比较,21例患者灌注延迟的区域均明显减少,其中内膜切除与支架血管成形术的近期疗效好。结论 灌注磁共振技术可以准确评价单侧前循环供血动脉狭窄的血流动力学状况,外科治疗可以明显改善这种血流动力学障碍。

Evaluation by perfusion-weighted magnetic resonance to hemodynamic character and surgical effect of carotid system stenoses or occlusion

Objective To evaluate hemodynamic character and surgical effect of stenoses or occlusion of carotid artery system by perfusion weighted MRI. Methods Twenty one patients with stenoses or occlusion of carotid artery system underwent surgical treatment. Two patients underwent endarterectomy, extracranial intracranial arterial bypass to 10 patients, and percutaneous stent angioplasty to 9 patients. Results Preoperative perfusion weighted magnetic resonance (MR)revealed normal regional cerebral blood flow in all patients, with delayed time to peak in both middle cerebral artery distribution and border zone. Postoperative perfusion weighted MR revealed normal time to peak in border zone, but abnormal in middle cerebral artery distribution. Evaluated by perfusion weighted MR, it showed that surgical method can improve the hemodynamic disorder of this kind of disease. The early curative effect of endarterectomy and percutaneous stent angioplasty is better than extracranial intracranial arterial bypass. Conclusions Perfusion weighted MR is a good method to evaluate hemodynamic character of stenoses or occlusion of carotid artery system. Surgical method is helpful to this kind of disease, and its curative effect can be evaluated impersonally and accurately by this new technique.