本文選題：準(zhǔn)連續(xù)式動(dòng)脈自旋標(biāo)記 + pCASL　； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景腦血管意外(CVA),又稱腦卒中,是指腦血管疾病的患者因各種誘發(fā)因素引起腦內(nèi)動(dòng)脈狹窄、閉塞或破裂,而造成急性腦血液循環(huán)障礙,臨床上表現(xiàn)為一次性或永久性腦功能障礙的癥狀和體征。是危害人類健康的常見(jiàn)疾病之一,具有發(fā)病率高、死亡率高、致殘率高等特點(diǎn)。據(jù)我國(guó)流行病學(xué)調(diào)查結(jié)果推算,腦卒中年發(fā)病率約為210/10萬(wàn),死亡率約為65/10萬(wàn),幸存者中有70%-80%遺留有不同程度的殘疾,近一半患者生活不能自理,給社會(huì)和家庭帶來(lái)沉重的負(fù)擔(dān)。其中,缺血性腦血管疾病(ICVD)約占70%,包括短暫性腦缺血發(fā)作、腦梗死。究其原由,主要因腦供血血管狹窄或閉塞等,致所灌注的腦組織區(qū)域供血失代償,出現(xiàn)中樞神經(jīng)系統(tǒng)病變有關(guān)。因此,及早發(fā)現(xiàn)并明確供血血管病變是控制疾病危害性的關(guān)鍵,為患者早期診斷、及時(shí)治療提供方向。目前主要采取數(shù)字減影血管造影(DSA)、CT血管成像(CTA)、磁共振血管造影(MRA)等方法進(jìn)行診斷。數(shù)字減影血管造影(Digital Subtraction Angiography,DSA)通過(guò)導(dǎo)管注入顯影劑血管濃性碘,在顯影劑到達(dá)目標(biāo)血管之前至目標(biāo)血管內(nèi)對(duì)比劑濃度達(dá)最高峰及顯影劑被廓清的時(shí)間段內(nèi),對(duì)檢查部位連續(xù)成像,并將該連續(xù)成像結(jié)果中不含顯影劑圖像為蒙片,與含有顯影劑圖像形成減影對(duì),通過(guò)采用計(jì)算機(jī)對(duì)其組成的圖像數(shù)字矩陣進(jìn)行減影成像,抵消掉骨骼與軟組織部分,最后形成血管影像。DSA是目前診斷血管形態(tài)異常的金標(biāo)準(zhǔn),但因其費(fèi)用昂貴、有創(chuàng)、存在放射線暴露、操作復(fù)雜且耗時(shí)等缺陷,不適于作為初篩及普查。電子計(jì)算機(jī)斷層掃描血管成像(Computed Tomography angiography,CTA)是經(jīng)周圍靜脈快速注射碘對(duì)比劑,并在注入對(duì)比劑的充盈高峰期,采用螺旋CT對(duì)靶血管進(jìn)行高速多層次連續(xù)CT掃描,采集數(shù)據(jù)。掃描結(jié)束后,通過(guò)容積再現(xiàn)(volume rendering,VR)、曲面重建(curved planner reconstruction,CPR)等計(jì)算機(jī)軟件技術(shù)對(duì)圖像進(jìn)行后處理,重建合成三維立體血管圖像。CTA也需要對(duì)比劑進(jìn)行成像,也存在有輻射、碘對(duì)比劑過(guò)敏等缺陷。相比之下,具有無(wú)創(chuàng)、無(wú)對(duì)比劑、設(shè)備和后處理技術(shù)不斷地發(fā)展等特點(diǎn)的MRI技術(shù),在血管病變?cè)\斷的應(yīng)用越來(lái)越廣泛。磁共振血管造影(magnetic reconanceangiorgraphy,MRA)利用相位位移、流動(dòng)增強(qiáng)效應(yīng)等磁共振成像技術(shù),以周圍靜止的機(jī)體組織為參考物象,根據(jù)流動(dòng)的血液來(lái)顯示出被檢查者的血管情況。時(shí)間飛躍法磁共振血管成像(3D-TOF-MRA)是臨床常用的一種MRA技術(shù),具有很高的空間分辨力、定位準(zhǔn)確、任意方向、任意角度、掃描范圍廣、多種重建、成像序列多等特點(diǎn),可以連續(xù)完整的顯示病變血管的部位及范圍。在評(píng)估血管狹窄程度方面,3D-TOF-MRA與DSA具有很好的一致性。但是3D-TOF-MRA也有缺陷,例如通常只對(duì)顱內(nèi)較大動(dòng)脈及其Ⅰ～Ⅱ級(jí)分支的血管病變敏感,血流動(dòng)力學(xué)變化產(chǎn)生的渦流會(huì)夸大血管狹窄的程度等。于1992年由Detre JA等首次提出一種以動(dòng)脈血內(nèi)自由彌散的水質(zhì)子作為內(nèi)源性示蹤劑的新型的測(cè)量腦灌注的MRI技術(shù)——?jiǎng)用}自旋標(biāo)記(ASL)腦灌注MRI技術(shù)。該技術(shù)通過(guò)利用反轉(zhuǎn)脈沖標(biāo)記興趣區(qū)(ROI)上游的動(dòng)脈血,當(dāng)被標(biāo)記的血流進(jìn)入ROI血管后,開(kāi)始采集圖像,對(duì)標(biāo)記前、后的圖像進(jìn)行減影,獲得ROI的血流圖像;同時(shí)利用成像層的毛細(xì)血管區(qū)與組織水進(jìn)行自旋交換引起變化的局部組織縱向弛豫時(shí)間T1,將標(biāo)記前、后的ROI組織T1信號(hào)相減,獲得腦血流量。近年,ASL技術(shù)得到改良,推出準(zhǔn)連續(xù)式(pCASL)。pCASL具有標(biāo)記效能較高,無(wú)需注入釓對(duì)比劑;無(wú)需額外硬件設(shè)備;磁化傳遞效應(yīng)輕;射頻能量沉積少;圖像信噪比高等特點(diǎn)。有研究用其判斷顱內(nèi)血管狹窄情況,發(fā)現(xiàn)pCASL與3.0T高分辨率磁共振(HR-MRI)在腦血管評(píng)估有較好的一致性,也有研究指出ASL較3D-TOF-MRA靈敏度和特異性更高,臨床選擇上存在爭(zhēng)議。為更好探討ASL在缺血性腦血管疾病診斷中的價(jià)值,以DSA為金標(biāo)準(zhǔn),探討pCASL和3D-TOF-MRA的靈敏性和特異性,并比較兩種診斷方法與DSA的吻合程度,以求為臨床應(yīng)用提供依據(jù)。目的研究比較準(zhǔn)連續(xù)式動(dòng)脈自旋標(biāo)記(pCASL)腦灌注MRI技術(shù)、時(shí)間飛躍法磁共振血管成像(3D-TOF-MRA)和數(shù)字減影血管造影(DSA)在缺血性腦血管疾病診斷中的價(jià)值。方法(1)病例來(lái)源患者來(lái)源于2016年1月至2017年1月間經(jīng)我院神經(jīng)外科診治考慮缺血性腦血管疾病者。(2)納入標(biāo)準(zhǔn)①突然出現(xiàn)以下癥狀:一側(cè)肢體(伴或不伴面部)無(wú)力或麻木;或一側(cè)面部麻木或口角歪斜;或說(shuō)話不清或理解語(yǔ)言困難;或雙眼向一側(cè)凝視;或一側(cè)或雙眼視力喪失或模糊;或眩暈伴嘔吐;或既往少見(jiàn)的嚴(yán)重頭痛、嘔吐;或意識(shí)障礙或抽搐者;②病情穩(wěn)定者,配合檢查者;③簽署知情同意書者。(3)排除標(biāo)準(zhǔn)① 煙霧病、血管炎等非動(dòng)脈粥樣硬化性血管疾病者;②腦內(nèi)出血、腦內(nèi)腫瘤、顱腦外傷等其他神經(jīng)系統(tǒng)疾病的患者;③體內(nèi)無(wú)金屬類物質(zhì)(心臟起搏器或顱內(nèi)動(dòng)脈夾),且無(wú)幽閉空間恐懼癥者;④對(duì)造影劑過(guò)敏者;⑤有嚴(yán)重心、肺、肝、腎疾病者;⑥圖像質(zhì)量差者。(4)中止標(biāo)準(zhǔn)患者依從性差,或發(fā)生嚴(yán)重不良事件,或出現(xiàn)其他病證不宜繼續(xù)接受觀察者,予以中止。(5)病例詳細(xì)資料最終納入88例,其中男53例,女35例,平均年齡(67.82±5.35)歲,既往有高血壓病史者67例,有糖尿病病史者13例。(6)檢查設(shè)備與方法所有納入88例患者均進(jìn)行pCASL、3D-TOF-MRA和DSA檢查,檢查時(shí)間:pCASL、3D-TOF-MRA均于發(fā)病后24h內(nèi)進(jìn)行,DSA于MRI檢查后24h內(nèi)進(jìn)行。①DSA檢查要求所有檢查者手術(shù)前6小時(shí)禁食。使用數(shù)字減影血管造影機(jī)(西門子公司,德國(guó))進(jìn)行DSA檢測(cè):采用Seldinger技術(shù),經(jīng)股動(dòng)脈穿刺,選擇性插管入頸內(nèi)動(dòng)脈和椎動(dòng)脈后,注入適量非離子型造影劑,依次造影,獲取圖像。② 3D-TOF-MRA 和 pCASL 檢查所有研究對(duì)象的MR掃描均采用Philips Ingenia 3.0T磁共振成像系統(tǒng)。T1W1掃描參數(shù):重復(fù)時(shí)間(repetition time,TR)2045 ms,回波時(shí)間(echo time,TE)20 ms,視野(Field of view,FOV)230 × 230 mm,矩陣(Matrix)356× 215,層厚(slice thickness)5.5 mm,層間隔(intersectiongap)1 mm,層數(shù)(slices)21。T2W1 掃描參數(shù):TR 9000 ms,TE 120ms,FOV 230 × 230 mm,Matrix 328 ×201,slice thickness 5.5,intersection gap 1 mm,slices 21。3D-TOF-MRA 掃描參數(shù):TR23 ms,TE 3.5 ms,翻轉(zhuǎn)角(flipangle,FA)18 °,FOV 201 × 201 mm,Matrix 404 × 256,slice thickness 0.8 mm,intersection gap 0 mm,slices 160。pCASL 掃描參數(shù):FFE 技術(shù),TR4000ms,TE16ms,FA90°,FOV240×240 mm,Matrix 88 × 88,slice thickness 6 mm,intersection gap 1 mm,slices 16。(7)血管狹窄程度測(cè)定以及影像學(xué)分析在MR后處理工作站對(duì)ASL圖像數(shù)據(jù)依次進(jìn)行校正、獲取腦血流量(CBF)圖、獲取感興趣區(qū)(ROI)、測(cè)量CBF值。通過(guò)與鏡側(cè)血管比較,判斷患側(cè)腦血流量灌注是否異常。3D-TOF-MRA和DSA圖像由兩名高年資醫(yī)師分別獨(dú)立在工作站上人工勾畫測(cè)量獲得血管狹窄率,并根據(jù)北美癥狀性頸動(dòng)脈狹窄內(nèi)膜切除協(xié)作研究組提出計(jì)算狹窄率的測(cè)量標(biāo)準(zhǔn)對(duì)圖像進(jìn)行分析,二者結(jié)論不一致時(shí),協(xié)商判定,若不能解決,請(qǐng)第三方進(jìn)行裁定。狹窄率(%)=(1—?jiǎng)用}最狹窄處血管寬度/狹窄病變遠(yuǎn)端的正常血管直徑)×100%。當(dāng)狹窄率50%,為輕度狹窄;在50%-69%,為中度狹窄;在70%-99%,為重度狹窄;管壁完全閉塞或未見(jiàn)顯影,為100%狹窄或閉塞。若1個(gè)病例中有多處狹窄者,只選擇一處最嚴(yán)重的進(jìn)行判定,且各方法評(píng)價(jià)部位為同一部位。以DSA為參照標(biāo)準(zhǔn),若DSA顯示為供血血管狹窄,且pCASL顯示為患側(cè)同一供血血管灌注異常,或者都為未見(jiàn)異常,二者診斷一致,否則為不一致;MRA則需顯示同一供血血管狹窄,或者都是未見(jiàn)異常,二者方為診斷一致,否則為不一致。計(jì)算3D-TOF-MRA和pCASL判斷顱內(nèi)血管狹窄的敏感性、特異性、準(zhǔn)確度。(8)試驗(yàn)過(guò)程中患者不良事件發(fā)生情況(9)統(tǒng)計(jì)方法使用SPSS20.0 for windows軟件包進(jìn)行統(tǒng)計(jì)學(xué)分析,以P0.05為有統(tǒng)計(jì)學(xué)差異。結(jié)果(1)DSA檢出顱內(nèi)動(dòng)脈狹窄79例,9例為其它腦血管疾病,發(fā)生率為89.77%。pCASL檢出顱內(nèi)動(dòng)脈狹窄74例,14例為其它腦血管疾病,發(fā)生率為84.09%。3D-TOF-MA檢出73例,5例為其它腦血管疾病,發(fā)生率為82.95%。(2)以DSA為對(duì)照,pCASL檢出顱內(nèi)動(dòng)脈狹窄靈敏度為91.14%,特異性為77.78%,準(zhǔn)確度為89.77%,兩種方法比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),兩種方法吻合度一般(K=0.553,P0.05)。(3)以DSA為對(duì)照,3D-TOF-MRA檢出顱內(nèi)動(dòng)脈狹窄靈敏度為87.34%,特異性為55.56%,準(zhǔn)確度為84.09%,兩種方法比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),兩種方法吻合度較弱(K=0.331,P0.05)。(4)觀察過(guò)程中患者無(wú)不良事件發(fā)生。結(jié)論(1)盡管pCASL、3D-TOF-MRA分別與DSA在缺血性腦血管疾病患者顱內(nèi)動(dòng)脈狹窄判斷上具有較高的一致性,但是pCASL和DSA吻合度更高。而且在評(píng)估急性缺血性腦血管疾病時(shí),影像檢查需要快速高效,pCASL可以在較短的時(shí)間內(nèi)提供重要的血流動(dòng)力學(xué)信息,與3D-TOF-MRA相比,優(yōu)勢(shì)突出。(2)但pCASL無(wú)法獲取動(dòng)脈影像,因此,在缺血性腦血管疾病的影像學(xué)檢查時(shí),建議在3D-TOF-MRA上,加掃pCASL以進(jìn)行觀察判斷,提高陽(yáng)性發(fā)現(xiàn)。
[Abstract]:Background cerebral vascular accident (CVA), also known as stroke, refers to the patients with cerebrovascular disease caused by various inducing factors that cause cerebral artery stenosis, occlusion or rupture, and cause acute cerebral blood circulation disorder. Clinical manifestations are symptoms and signs of one-time or permanent cerebral dysfunction. It is one of the common diseases endangering human health. It is characterized by high morbidity, high mortality and high disability rate. According to the results of epidemiological investigation in China, the incidence of cerebral death is about 210/10 million and the mortality rate is about 65/10 million. Among the survivors, 70%-80% has a different degree of disability, nearly half of the patients can't take care of themselves and bring a heavy burden to the society and family. Vascular disease (ICVD) accounts for about 70%, including transient ischemic attack, cerebral infarction, which is mainly due to the stenosis or occlusion of blood supply vessels in the brain, resulting in blood supply decompensation and central nervous system lesion in the cerebral region of the perfusion. Therefore, early detection and clear blood vessel disease are the key to control the disease harm. Early diagnosis and timely treatment provide direction. Currently, digital subtraction angiography (DSA), CT angiography (CTA), magnetic resonance angiography (MRA) and other methods are used to diagnose. Digital subtraction angiography (Digital Subtraction Angiography, DSA) is injected into the vascular concentration iodine through the catheter through the catheter, before the developer reaches the target vessel. In the time segment of the target intravascular contrast agent concentration and the developer to be cleared, continuous imaging of the inspection site, and the continuous imaging results without the developer image as the mask, and the subtraction image containing the developer image, are subtracted by the image digital matrix made up of the computer to offset the bone loss. The soft tissue section and the final formation of vascular image.DSA is the gold standard for the diagnosis of vascular abnormalities, but because of its expensive, invasive, radiological exposure, complicated operation and time-consuming defects, it is not suitable for screening and screening. Computed tomography angiography (Computed Tomography angiography, CTA) is the peripheral vein. Fast injection of iodine contrast agent, and at the peak period of filling the contrast agent, spiral CT is used to carry out high speed and multilevel continuous CT scan on the target vessel and collect data. After the scan, the image is reprocessed and reconstructed by the volume reproduction (volume rendering, VR), surface reconstruction (curved planner reconstruction, CPR) and so on. .CTA also needs contrast agents to be imaging, and there are also defects such as radiation and iodized contrast. In contrast, MRI technology with non-invasive, non contrast, equipment and post-processing technology is becoming more and more widely used in the diagnosis of vascular disease. Magnetic reconancea Ngiorgraphy, MRA) using the phase displacement, the flow enhancement effect and other magnetic resonance imaging techniques, using the surrounding body tissue as the reference image, according to the flow of blood to show the condition of the blood vessel of the examiner. The time leap method magnetic resonance angiography (3D-TOF-MRA) is a common MRA technique in the bed, and has a high spatial resolution. 3D-TOF-MRA is well consistent with DSA in assessing the degree of vascular stenosis. However, 3D-TOF-MRA is also defective, for example, only the larger intracranial arteries and their ones are usually limited. The vascular lesions of class I to class II branches are sensitive, and the eddy current produced by hemodynamic changes will exaggerate the degree of vascular stenosis. In 1992, a new type of MRI technique for measuring cerebral perfusion, including arterial spin labeling (ASL) cerebral perfusion MRI, was first proposed by Detre JA and so on as an endogenous tracer. The technique uses the reverse pulse to mark the arterial blood upstream of the region of interest (ROI). When the labeled blood flow enters the ROI blood vessel, it begins to collect the image, subtracting the image before and after the marking, and obtaining the blood flow image of the ROI, and using the capillary zone of the imaging layer and the tissue water to make the local tissue longitudinal change caused by the spin exchange. In recent years, the ASL technology has been improved, and the ASL technology has been improved, and the ASL technology has been improved in recent years. In recent years, the quasi continuous (pCASL).PCASL has high labeling efficiency and no need to be injected into the gadolinium contrast agent; no additional hardware equipment is needed; the magnetization transfer effect is light; the radio frequency energy deposition is low; the image signal to noise ratio is high. The research is used for research. In judging the situation of intracranial vascular stenosis, it is found that pCASL and 3.0T high resolution magnetic resonance (HR-MRI) have good consistency in cerebrovascular evaluation. There are also studies pointing out that ASL is more sensitive and specific than 3D-TOF-MRA, and there is a dispute in clinical selection. In order to better explore the value of ASL in the diagnosis of ischemic cerebrovascular disease, DSA is the gold standard. To discuss the sensitivity and specificity of pCASL and 3D-TOF-MRA, and to compare the two diagnostic methods with DSA in order to provide the basis for clinical application. Objective to compare the quasi continuous arterial spin labeling (pCASL) cerebral perfusion MRI, the time leap method magnetic resonance angiography (3D-TOF-MRA) and the digital subtraction angiography (DSA) in the ischemic brain. The value of the diagnosis of vascular disease. Method (1) the patients were derived from January 2016 to January 2017 with the treatment of ischemic cerebrovascular disease in the Department of Neurosurgery of our hospital. (2) the following symptoms were included in the standard: one limb (with or without facial) weakness or numbness; or one side facial numbness or angular skewness; or an indistinct speech. Or to understand language difficulties; or to gaze to one side; or the loss or blurring of vision or blur on one side or both eyes; or dizziness and vomiting; or previously uncommon severe headache, vomiting, or conscious disturbance or convulsion; (2) patients with stable condition, who cooperate with the examiners; (3) sign informed consent. (3) exclude the standard of moyamoya disease, vasculitis, and other non atherosclerosis Patients with sexual vascular diseases; (2) patients with intracerebral hemorrhage, intracerebral tumor, craniocerebral trauma and other nervous system diseases; (3) the body without metal substances (cardiac pacemaker or intracranial artery clip), and no claustrophobic space phobias; (4) allergic to contrast agents; (5) patients with serious heart, lung, liver and kidney disease; (6) poor image quality. (4) terminate standard patients dependent (5) the case detailed information was finally included in 88 cases, including 53 men, 35 women, average age (67.82 + 5.35), 67 patients with past history of hypertension, and 13 patients with a history of hypertention. (6) all the examination equipment and methods were included in 88 patients. All the pCASL, 3D-TOF-MRA and DSA examinations were performed: pCASL, 3D-TOF-MRA were performed within 24h after the onset of the disease. DSA was performed in 24h after MRI examination. (1) DSA examination required all examiners to fasting 6 hours before operation. Use digital subtraction angiography (SIEMENS, Germany) for DSA detection: Seldinger technique, femoral artery puncture, selection After the selective intubation into the internal carotid artery and the vertebral artery, an appropriate amount of nonionic contrast media was injected, and the images were obtained in turn. (2) all the MR scans of the 3D-TOF-MRA and pCASL examinations were examined by the.T1W1 scanning parameters of the Philips Ingenia 3.0T magnetic resonance imaging system: the repetition time (repetition time, TR) 2045 MS, and the echo time (echo, 20) MS, Field of view (FOV) 230 x 230 mm, matrix (Matrix) 356 x 215, layer thickness (slice thickness) 5.5 mm, layer interval (intersectiongap) 1 mm. MS, TE 3.5 ms, flipangle, FA 18 degrees, FOV 201 x 201 mm, Matrix 404 x 256, slice thickness 0.8 mm, intersection 0, 88 * 88, 88 * 88 And imaging analysis in order to correct the ASL image data in sequence at the post processing station of MR, obtain the brain blood flow (CBF) map, obtain the region of interest (ROI) and measure the CBF value. By comparing with the mirror side blood vessels, it is judged whether the abnormal.3D-TOF-MRA and DSA images of the blood flow perfusion in the affected side of the brain are artificially ticked on the workstation by two senior physicians. Draw blood vessel stenosis rate, and analyze the image according to the North American Symptomatic Carotid Stenosis endarterectomy cooperative research group to calculate the stenosis rate. When the two conclusions are inconsistent, the third parties are asked to decide. The narrowing rate (%) = (1 - the narrowest artery width / stenosis of the artery is far away). The normal vascular diameter at the end) * 100%. was 50%, mild stenosis, mild stenosis in 50%-69%, moderate stenosis, severe stenosis in 70%-99%, complete occlusion of the wall or no development, 100% stenosis or occlusion. If there were many stenosis in 1 cases, only one of the most serious criteria was selected and the evaluation sites were in the same site. DSA for the same site. For reference, if DSA showed stenosis of blood supply, and pCASL showed abnormal perfusion of blood vessels of the same blood vessel on the side of the affected side, or no abnormality, the two diagnosis was consistent, otherwise, MRA should show the same blood vessel stenosis or no abnormality, and the two is the same diagnosis, otherwise it is inconsistent. Calculation of 3D-TOF-MRA and pCASL To judge the sensitivity, specificity and accuracy of intracranial vascular stenosis (8) the occurrence of adverse events in the patients (9) statistical methods were statistically analyzed using SPSS20.0 for Windows software package, with statistical differences in P0.05. Results (1) 79 cases of intracranial artery stenosis were detected by DSA, 9 cases were other cerebrovascular diseases, and the incidence was 89.77%.pC ASL detected 74 cases of intracranial artery stenosis and 14 cases of other cerebrovascular diseases, 73 cases were detected by 84.09%.3D-TOF-MA, 5 were other cerebrovascular diseases, the incidence was 82.95%. (2) with DSA as the control, the sensitivity of intracranial artery stenosis detected by pCASL was 91.14%, the specificity was 77.78%, the accuracy was 89.77%, and the difference was not statistically significant. The difference was not statistically significant. (P0.05) the two methods were in general (K=0.553, P0.05). (3) the sensitivity of 3D-TOF-MRA in the detection of intracranial artery stenosis was 87.34%, the specificity was 55.56%, the accuracy was 84.09%, and the two methods were compared, the difference was not statistically significant (P0.05), and the two square methods were weak (K=0.331, P0.05). (4) there was no adverse event in the observation process. Conclusions (1) although pCASL, 3D-TOF-MRA and DSA have higher consistency in judging intracranial artery stenosis in patients with ischemic cerebrovascular disease, pCASL and DSA are more anastomosed. And in assessing acute ischemic cerebrovascular disease, imaging needs to be fast and efficient, and pCASL can provide important blood flow in a shorter time. Dynamic information, compared with 3D-TOF-MRA, has a prominent advantage. (2) but pCASL is unable to obtain arterial images. Therefore, in the imaging examination of ischemic cerebrovascular disease, it is suggested that on 3D-TOF-MRA, the scanning of pCASL can be used for observation and judgment to improve the positive discovery.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743

【參考文獻(xiàn)】

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1 周瑜;漆鉅霞;王小t，

本文編號(hào)：2116713