本文選題：動脈瘤性蛛網(wǎng)膜下腔出血　切入點：3D　出處：《石河子大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:探討磁共振三維動脈自旋標記(three-dimension arterial spin labeling,3D ASL)在動脈瘤破裂引發(fā)蛛網(wǎng)膜下腔出血后遲發(fā)性腦缺血中的早期臨床預(yù)測價值。方法:1、回顧性分析2015年11月~2016年6月我院收治的動脈瘤性蛛網(wǎng)膜下腔出血(aneurismal subarachnoid hemorrhage,a SAH)患者的臨床資料,所有患者均在動脈瘤破裂蛛網(wǎng)膜下腔出血后的3~14 d內(nèi)行磁共振3D ASL檢查,術(shù)后隨訪3個月,將所有aSAH患者自然分為DCI組和非DCI組,另外選取同期收治的10例動脈瘤未破裂出血患者作為對照組。2、將全部病例原始數(shù)據(jù)導入GE MR ADW4.6工作站進行移動校正及降噪處理后,利用Functool軟件進行圖像后處理,依據(jù)腦血管供血區(qū),同時結(jié)合偽彩圖顯示的腦血流灌注異常區(qū)定義感興趣區(qū)(region-of-interest,ROI),測定相應(yīng)區(qū)域的灌注參數(shù)值。3、采用SPSS 19.0統(tǒng)計軟件對數(shù)據(jù)進行分析。結(jié)果:1、30例a SAH患者中,11例發(fā)生了DCI,19例未發(fā)生DCI,aSAH后DCI的發(fā)生率為36.7%,DCI患者早期臨床危重狀態(tài)(Fisher3~4級)所占比例明顯高于非DCI組。2、DCI組、非DCI組和對照組患者的腦血流灌注異常程度存在差異,且差異有統(tǒng)計學意義(Chi-Square統(tǒng)計量為17.540,P=0.000)。aSAH患者腦血流灌注減低程度與改良Rankin評分(Modified Rankin Scale,mRS)評分呈顯著正相關(guān)(r=0.955,P=0.000)。aSAH后早期腦血流灌注(early cerebral blood flow perfusion,CBF)明顯減低的患者,發(fā)生DCI的風險會明顯增加。3、Logistic回歸分析顯示腦血流灌注減低程度(OR,0.453;95%CI,0.236~0.866;P 0.017)、改良Fisher分級(OR,0.127;95%CI,0.028~0.567;P 0.007)與DCI的發(fā)生顯著相關(guān),是DCI的危險因素。4、受試者工作曲線(receptor operation,ROC)曲線說明CBF值對DCI的預(yù)測價值尚不能確定,而CBF比值和AI值的ROC曲線下面積為0.9070.9,P值0.05,有統(tǒng)計學意義,說明二者對DCI早期診斷價值較高。結(jié)論:磁共振3D ASL作為一種有效的檢測工具,是目前常規(guī)腦灌注技術(shù)的有效補充,對DCI患者的早期診斷和aSAH患者的早期預(yù)后評估有重要價值。
[Abstract]:Objective: to investigate the early clinical predictive value of three-dimensional arterial spin labeling 3D ASL in delayed cerebral ischemia after subarachnoid hemorrhage caused by aneurysm rupture. Methods: 1, retrospective analysis was made from November 2015 to June 2016. Clinical data of patients with aneurysm subarachnoid hemorrhage (SAH) treated in our hospital. MRI 3D ASL was performed in all patients within 14 days after aneurysm rupture. All patients with aSAH were followed up for 3 months. All patients with aSAH were naturally divided into DCI group and non-#en3# group. In addition, 10 patients with unruptured aneurysm bleeding were selected as control group. The original data of all cases were imported into GE Mr ADW4.6 workstation for movement correction and noise reduction. The image was processed by Functool software. According to the blood supply area of cerebral vessels, At the same time, combined with the definition of abnormal area of cerebral blood flow perfusion shown by pseudo-color map, region-of-interest ROI was used to determine the perfusion parameter value of the corresponding area. The data were analyzed by SPSS 19.0 software. Results among the 30 patients with a SAH, 11 cases had DCII and 19 cases had DCI. The incidence of DCI in patients without DCI aSAH was 36.7%. The incidence of DCI was significantly higher than that of non-DCI group (36.7%), and the incidence of DCI was significantly higher than that of non-DCI group (36.7%), and the incidence of DCI was significantly higher than that of non-DCI group (36.7%). The degree of abnormal cerebral blood flow perfusion was different between non-#en0# group and control group. There was a significant positive correlation between the degree of cerebral blood flow perfusion reduction and the modified Rankin score modified Rankin scale mRSs in patients with cerebral blood flow perfusion of 17.540 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000, respectively. Logistic regression analysis showed that the degree of cerebral blood flow perfusion decrease was 0.45395% (P 0.017), and the risk of DCI was 0.127 ~ 95% (P 0.017). There was a significant correlation between the degree of cerebral blood perfusion reduction and the incidence of DCI. It is the risk factor of DCI. The operating curve indicates that the predictive value of CBF value to DCI is uncertain, while the area under ROC curve of CBF ratio and AI value is 0.9070.9 (P = 0.05), which has statistical significance. Conclusion: Mr 3D ASL, as an effective detection tool, is an effective supplement of conventional cerebral perfusion technique, and has important value in early diagnosis of DCI patients and early prognosis evaluation of aSAH patients.
【學位授予單位】：石河子大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3

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