本文關(guān)鍵詞： 短暫性腦缺血發(fā)作 動(dòng)脈自旋標(biāo)記 動(dòng)態(tài)磁敏感加權(quán)灌注成像 假連續(xù)式動(dòng)脈自旋標(biāo)記灌注成像 顱內(nèi)動(dòng)脈粥樣硬化 自旋標(biāo)記 動(dòng)脈到達(dá)時(shí)間 動(dòng)態(tài)磁敏感成像　出處：《中國人民解放軍醫(yī)學(xué)院》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：第一部分：多參數(shù)準(zhǔn)連續(xù)式動(dòng)脈自旋標(biāo)記與動(dòng)態(tài)磁敏感增強(qiáng)灌注成像在短暫性腦缺血發(fā)作中的對(duì)比研究目的：本研究采用多參數(shù)三維假連續(xù)式動(dòng)脈自旋標(biāo)記灌注成像(three-dimensional pseudo-continuous arterial spin labeling,3D pCASL)與動(dòng)態(tài)磁敏感增強(qiáng)灌注成像(dynamic susceptibility contrast enhanced perfusion-weight imaging, DSC PWI)對(duì)短暫性腦缺血發(fā)作(transient ischemic attack, TIA)患者進(jìn)行成像,比較兩者對(duì)責(zé)任病灶的檢出率。方法：連續(xù)納入39例臨床診斷TIA患者，并在首次發(fā)作24小時(shí)內(nèi)進(jìn)行磁共振檢查。掃描序列包括常規(guī)頭顱MR成像、MRA (magnetic resonance angiography, MRA), DW1、3D pCASL(選取兩個(gè)標(biāo)記延遲時(shí)間post-labeling time, PLD, PLD=1.5s及PLD=2.5s),DSC PWI。后處理獲取3D pCASL的腦血流(cerebral blood flow, CBF)圖像和DSC PWI的Tmax圖像。比較不同灌注方法與MRA及DWI結(jié)合法對(duì)于缺血病灶檢出率和缺血面積。結(jié)果：就TIA患者的缺血病灶檢出率而言,3D pCASL (PLD 1.5s及PLD2.5s)的CBF圖像與DSC PWI Tmax對(duì)比無差異;3D pCASL (PLD1.5s)的CBF圖像對(duì)于缺血的檢出率高于MRA結(jié)合DWI法;DSC PWI Tmax、3D pCASL (PLD2.5s)CBF與MRA結(jié)合DWI法無差異。就顯示低灌注面積而言,3D pCASL(PLD1.5s)的CBF圖像顯示的面積最大,其次是DSC PWI Tmax,而3D pCASL (PLD2.5s)的CBF圖像顯示的低灌注面積最小。結(jié)論：3D pCASL腦灌注成像技術(shù)無創(chuàng)、快速、可重復(fù)性強(qiáng),推薦作為臨床可疑TIA患者的影像篩查手段,不同PLD的3D pCASL序列對(duì)于病灶的檢出及缺血面積的顯示有差異,選擇較短PLD有可能提高病灶的檢出率。第二部分：增強(qiáng)型準(zhǔn)連續(xù)動(dòng)脈自旋標(biāo)記灌注成像技術(shù)對(duì)于重度顱內(nèi)粥樣硬化性狹窄低灌注定量測(cè)量的研究目的：本研究采用多參數(shù)增強(qiáng)型準(zhǔn)連續(xù)式動(dòng)脈自旋標(biāo)記動(dòng)脈成像(enhance pseudo-continuous arterial spin labeling, e-pCASL)獲取顱內(nèi)動(dòng)脈粥樣硬化性狹窄患者腦血流量(cerebral blood flow, CBF)圖,并與傳統(tǒng)的動(dòng)態(tài)磁敏感增強(qiáng)灌注成像(dynamic susceptibility contrast enhanced perfusion-weight imaging, DSC PWI)及準(zhǔn)連續(xù)式動(dòng)脈自旋標(biāo)記灌注成像(pseudo-continuous arterial spin labeling, pCASL)進(jìn)行比較，，使用DSC PWI為金標(biāo)準(zhǔn),對(duì)比研究三種灌注方式測(cè)量CBF比值的差異性與相關(guān)性。方法：納入重度顱內(nèi)動(dòng)脈粥樣硬化性狹窄患者39例，同時(shí)行e-pCASL、pCASL和DSC PWI成像,根據(jù)狹窄動(dòng)脈責(zé)任供血區(qū)域,經(jīng)驗(yàn)性手工勾勒感興趣區(qū)(ROI)進(jìn)行測(cè)量,獲得CBF值,使用鏡像法獲得對(duì)側(cè)CBF比值,對(duì)三種灌注方式的CBF比值進(jìn)行SNK方差分析。同時(shí)基于e-pCASL獲取動(dòng)脈通過時(shí)間(arterial transit time,ATT)，基于DSC PWI獲取最大達(dá)峰時(shí)間(time to peak TTP)。使用ATT和TTP進(jìn)行分層分析,對(duì)于e-pCASL CBF比值、pCASL CBF比值與DSC PWI rCBF比值進(jìn)行析因方差分析和相關(guān)性分析。結(jié)果e-pCASL CBF比值與DSC PWI rCBF比值相關(guān)性(r=0.871)高于pCASL CBF比值與DSC PWI rCBF比值相關(guān)性(r=0.642)。使用TTP分層數(shù)據(jù)顯示，TTP及灌注方法的選擇在重度動(dòng)脈狹窄患者患側(cè)與健側(cè)的CBF比值中無明顯差異。根據(jù)ATT分組顯示，e-pCASL CBF與DSC PWI rCBF比值的相關(guān)性在不同ATT時(shí)間均較高。結(jié)論：e-pCASL在重度動(dòng)脈狹窄患者中與DSC PWI在CBF定量測(cè)量中一致性和相關(guān)性較好,且不受ATT因素的影響,具有準(zhǔn)確、簡(jiǎn)便、無刨、可重復(fù)性好的特點(diǎn)。
[Abstract]:The first part: the comparison of multi parameter quasi continuous arterial spin labeling and dynamic susceptibility contrast perfusion imaging in transient ischemic attack: This study adopts multi parameter three-dimensional pseudo continuous arterial spin labeling (three-dimensional pseudo-continuous arterial spin labeling, 3D pCASL) and dynamic susceptibility contrast perfusion imaging (dynamic susceptibility contrast enhanced perfusion-weight imaging, DSC PWI) for transient ischemic attack (transient ischemic attack, TIA) for imaging patients, compared to the detection rate of lesions responsible. Methods: a total of 39 consecutive patients with a clinical diagnosis of TIA patients, and magnetic resonance imaging in the first attack within 24 hours. The scanning sequences included conventional MR imaging MRA (magnetic resonance, angiography, MRA), DW1,3D pCASL (select two mark delay time post-label Ing time, PLD, PLD=1.5s and PLD=2.5s), DSC PWI. postprocessing of cerebral blood flow to obtain 3D pCASL (cerebral blood flow, CBF Tmax and DSC PWI) image. Comparison of different perfusion methods with MRA and DWI combined method for ischemic lesion detection rate and ischemic area. Results: the detection of TIA in patients with ischemic lesions the rate of 3D, pCASL (PLD 1.5s and PLD2.5s CBF) and DSC PWI Tmax image contrast has no difference; 3D pCASL (PLD1.5s) CBF image for ischemia detection rate is higher than that of MRA combined with DWI DSC PWI Tmax, 3D; pCASL (PLD2.5s) CBF and MRA combined with DWI method. No difference showed low perfusion area 3D, pCASL (PLD1.5s) CBF image display area is the largest, followed by DSC PWI Tmax, and 3D pCASL (PLD2.5s) CBF images showed the low perfusion area minimum. Conclusion: 3D pCASL brain perfusion imaging is non-invasive, rapid, reproducible, recommended as clinically suspected TIA Image screening method for patients with 3D, pCASL PLD are different for different sequence detection and display area of ischemic lesions, choose shorter PLD may improve the detection rate of lesions. The second part: enhanced quasi continuous arterial spin labeling for the purpose of severe intracranial atherosclerotic stenosis: quantitative measurement of low perfusion this research adopts multi parameter enhanced quasi continuous arterial spin labeling (enhance pseudo-continuous arterial spin artery imaging labeling, e-pCASL) for intracranial atherosclerotic stenosis in patients with cerebral blood flow (cerebral blood, flow, CBF), and the traditional dynamic magnetic susceptibility enhancement perfusion imaging (dynamic susceptibility contrast enhanced perfusion-weight imaging, DSC and PWI) quasi continuous arterial spin labeling (pseudo-continuous arterial spin labeling, pCASL). For comparison, the use of DSC PWI as the gold standard, the difference comparison of three kinds of perfusion measurements of CBF ratio and correlation. Methods: in patients with severe intracranial atherosclerotic stenosis in 39 cases, while e-pCASL, pCASL and DSC PWI imaging, according to arterial stenosis of feeding area, empirical hand sketched a region of interest (ROI) measure the CBF value, the ratio of CBF side using mirror method, the ratio of CBF to three kinds of perfusion SNK variance analysis. At the same time, based on the e-pCASL obtained through time (arterial transit artery time, ATT, DSC) based on PWI to obtain the peak time (time to peak TTP) using ATT and TTP. Stratified analyses were performed for the e-pCASL pCASL CBF ratio, CBF ratio and DSC PWI ratio of rCBF factorial variance analysis and correlation analysis. The results of e-pCASL CBF and DSC PWI rCBF ratio Ratio correlation (R =0.871) was higher than that of pCASL CBF The value of DSC PWI rCBF and the ratio of correlation (r=0.642). Using the TTP hierarchical data show that no significant difference between the CBF ratio and TTP perfusion method in patients with severe arterial stenosis and the contralateral side of the ATT packet. According to the correlation between e-pCASL and DSC showed that CBF PWI rCBF ratio of ATT at different time were higher. Conclusion: e-pCASL in severe artery stenosis in patients with DSC and PWI CBF in the quantitative measurement of consistency and correlation, and is not affected by the factors of ATT, accurate, simple, noninvasive, reproducible characteristics.

【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R445.2;R743

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