血管编码动脉自旋标记技术在烟雾病直接脑血运重建术中的应用

目的 探讨血管编码动脉自旋标记技术（vessel encoded arterial spin-labeling，VE-ASL）在评估烟雾病直接脑血管搭桥手术中的应用价值。方法 选取2017年8月至2019年5月首都医科大学附属北京天坛医院接受颞浅动脉-大脑中动脉搭桥手术治疗的烟雾病患者56例，所有患者术前和术后均接受头部3.0T MR-ASL扫描，分别评估双侧颈内动脉、颈外动脉和基底动脉供血情况，搭桥血管的供血范围通过标记的颞浅动脉来评估，CT脑灌注成像结果作为对比。结果 56例患者中，搭桥区域术前平均脑血流量（cerebral blood flow，CBF）为（349±55）mL·kg^-1·min^-1，术后7 d平均CBF为（558±74）mL·kg^-1·min^-1（P<0.01）。术后7 d，36例（64.2%）患者颞浅动脉VE-ASL显示搭桥血管向脑内的供血，20例（35.7%）未显示供血，术后3个月复查VE-ASL，其中6例显示颞浅动脉恢复向颅内供血；术后7 d脑血流灌注成像（computed tomography perfusion，CTP）显示39例（69.6%）患者搭桥侧脑血流灌注明显改善，术后3个月CTP显示44例（78.5%）搭桥侧脑血流灌注明显改善。术后7 d和术后3个月VE-ASL和CTP对CBF改善评估均具有很好的一致性（术后7 d，Kappa=0.718；术后3个月，Kappa=0.744）。结论 VE-ASL能很好评估烟雾病直接搭桥手术中搭桥血管供血范围和脑血管灌注状态变化，值得临床推广。

Application of vessel encoded arterial spin-labeling magnetic resonance imaging in revascularization surgery in patients with Moyamoya disease

Objective To explore the clinical value of vessel encoded arterial spin-labeling (VE-ASL) magnetic resonance in evaluating direct revascularization in patients with moyamoya disease. Methods Fifty-six patients with Moyamoya disease who underwent middle cerebral artery (MCA)-superficial temporal artery (STA) anastomosis in Beijing Tiantan Hospital were retrospectively analyzed. 3.0T VE-ASL was performed preoperatively and within 1 week postoperatively. Preoperative and postoperative perfusion territories of the bilateral internal carotid arteries, bilateral external carotid arteries, and basilar artery were examined, and the revascularization area was examined by labeling the superficial temporal artery-to-middle cerebral artery bypass postoperatively. Computed tomography angiography (CTP) was performed and compared with VET-ASL results. Results Of the 56 patients, mean values of cerebral blood flow (CBF) from VE-ASL in the anastomosis side at preoperative assessment and 7 days postoperative follow-up were (349±55) mL·kg^-1·min^-1 and (558±74) mL·kg^-1·min^-1 (P<0.01),respectively. At 7days after operation, 36(64.2%)patients VE-ASL demonstrated the blood flow from STA, whereas 20(35.7%)patients had no blood flow from STA. Of them, 6 patients restore blood flow from STA at 3 months after operation. Compared with VE-ASL, CBF of 39(69.6%) and 44(78.5%) patients was improved at 7 days and 3 months, respectively, after operation based on CTP scan. There was good intermodality agreement between VE-ASL and CTP in evaluating the CBF changes at 7days or 3 months after revascularization (7 days Kappa=0.718; 3 months,Kappa=0.744). Conclusion VE-ASL is a promising technique in evaluation of patients with Moyamoya disease, which could provide quantitative assessment of the postoperative CBF changes after direct revascularization.