动脉自旋标记技术在儿童烟雾病脑灌注和侧支代偿评估中的应用

目的探讨动脉自旋标记(arterial spin labeling,ASL)技术在儿童烟雾病脑灌注和侧支血管代偿评估中的应用价值。方法纳入2016年5月-2017年10月首都医科大学附属北京天坛医院连续收治的症状性儿童烟雾病患者的临床资料,所有患者术前均接受ASL、CTP和DSA检查。从以下两个方面评价ASL与CTP的一致性:定性评价脑低灌注、定量评价基于感兴趣区(region of interest,ROI)的脑血流量(cerebral blood flow,CBF)和血流时间参数;同时评价ASL与DSA评估侧支代偿的一致性。结果研究最终纳入13例患者共计189个ROI。定性分析中,ASL和CTP对灌注异常评价一致性上在排除3例影像存在明显动脉通过伪影(arterial transit artifact,ATA)(3级)的患者后,两种影像间评价一致性提高(κ=0.398,P<0.001);定量分析中,CTP与ASL影像的绝对CBF值正相关(r=0.413,95%CI 0.287~0.525,P<0.001),ASL影像计算的空间变异系数(coefficient of variation,CoV)与CTP影像中平均通过时间(mean transit time,MTT)的绝对值正相关(r=0.484,95%CI 0.367~0.587,P<0.001)。评价侧支血管方面,ASL上的ATA强度和DSA侧支血管代偿等级一致性良好(κ=0.680,P<0.001)。结论无创ASL技术对儿童烟雾病脑血流灌注和侧支血管代偿评估可行,具有很好的临床应用价值。

Application Value of Arterial Spin Labeling in Evaluating Cerebral Perfusion and Collateral Circulation in Children Patients with Moyamoya Disease

Objective To investigate the application value of arterial spin labeling (ASL) in evaluating cerebral
hemodynamics and collateral vessels in pediatric moyamoya disease.
Methods The pediatric patients diagnosed as moyamoya in Department of Neurosurgery, Beijing
Tian Tan Hospital from May 2016 to October 2017 were enrolled in this study. All the patients
underwent ASL, CTP and whole brain DSA before the surgery. The coherence of ASL and CTP was
evaluated from the two aspects: qualitative evaluation of cerebral hypoperfusion, and quantitative
analysis of cerebral blood flow (CBF) based on region of interest (ROI) and time parameters. The
coherence of ASL and DSA in evaluating collateral vessels was also analyzed.
Results A total of 189 ROIs in 13 patients were finally included. In qualitative analysis, after
excluding 3 patients with obvious arterial transit artifacts (ATA), the coherence between ASL and CTP
in evaluating cerebral hypoperfusion was increased (κ =0.398, P <0.001); in quantitative analysis, CBF
obtained from ASL and CTP showed positive correlation (r =0.413, 95%CI 0.287-0.525, P <0.001), the
spatial coefficient of variation (CoV) on ASL also showed positive correlation with mean transit
time (MTT) on CTP (r =0.484, 95%CI 0.367-0.587, P <0.001). The coherence between ASL andDSA in evaluating collateral vessels was also good (κ =0.680, P <0.001).
Conclusions The non-invasive and radiation free ASL technique is ideal in evaluating cerebral
perfusion and collateral vessels in pediatric patients with moyamoya disease, and it is promising in
clinical application.