動脈自旋標記技術在PAOD患者小腿肌灌注方面的可重復性測量
發(fā)布時間：2018-11-19 11:26
【摘要】：目的:這項研究假設動脈自旋標記核磁共振成像技術在3.0T掃描儀上測量健康志愿者和周圍血管病患者小腿肌結扎前后血流灌注方面將是一種可靠無創(chuàng)的技術,并且將對這兩個組群進行區(qū)分。以往的研究工作證實了釓對比劑的首過效應在周圍血管病患者小腿肌灌注測量的實用性。然而,患有周圍血管病的患者通常會有進展性的腎疾病,所以不能接受釓對比劑。應用動脈自旋標記測量小腿肌灌注的一大優(yōu)勢就是不用釓對比劑。方法:周圍血管病患者的特征有跛行,踝肱指數0.4-0.9。正常對照組年齡要匹配,并且沒有周圍血管病的任何風險因素。收集周圍血管病患者15名,健康對照者30名。所有受試者都采取仰臥位,并以套袖止血帶進行結扎以達到缺血后反應性充血,在3.0T掃描儀上對受試者進行掃描。掃描后獲得61幅ASL原始圖像,通過運動矯正后再進行信號平均得到動脈自旋標記血流量圖。灌注峰值是在ASL血流量圖上最大信號強度處取ROI測得,本次研究選取的是比目魚肌的最大血流值。灌注測量研究是在周圍血管病患者與正常對照組之間進行,而可重復性研究通過12個受試者(5個正常對照,7個周圍血管病患者)重復測量來完成。結果:通過對磁共振成像結果分析得出30名健康對照者(年齡,52±10歲)的肌灌注峰值(peak perfusion,PP)為61±13ml/min-100g,15名周圍血管病患者(年齡:63±9歲,踝肱指數:0.68±0.11)的PP值為37±9ml/min-100g,健康對照組明顯高于周圍血管病患者。兩獨立樣本T檢驗結果顯示95%的可信區(qū)間不跨0,我們可以認為兩組數據均值差異具有統(tǒng)計學意義,作為可重復性測量設計的研究結果顯示,12名受試者測量前后結果的組內相關系數(intraclass correlation coefficient ICC)為0.94,(95%的可信區(qū)間95%confidence interval[CI]:0.80-0.98),對45名受試者兩位觀察者間的組內相關系數為0.98%,(95%的可信區(qū)間[CI]:0.96-0.99)。結論:動脈自旋標記技術是一種可重復性非創(chuàng)傷性的技術在測量小腿肌灌注方面。動脈自旋標記技術可以對正常人群與周圍血管病患者進行辨別。這項科技會證實它在提高肌灌注臨床治療方案上的作用,特別是對于那些不能接受釓對比劑的患者。
[Abstract]:Objective: this study hypothesized that arterial spin-labeled magnetic resonance imaging would be a reliable and noninvasive technique for measuring blood perfusion in healthy volunteers and patients with peripheral vascular disease before and after ligation of the leg muscles on a 3.0T scanner. And the two groups will be distinguished. Previous studies have confirmed the usefulness of the first-pass effect of gadolinium contrast agents in the measurement of leg muscle perfusion in patients with peripheral angiopathy. However, patients with peripheral vascular disease usually have progressive kidney disease, so gadolinium contrast agents are not acceptable. One advantage of using arterial spin labeling to measure leg muscle perfusion is the use of gadolinium contrast agents. Methods: the features of peripheral vascular disease were claudication, ankle brachial index (malleolus index) 0.4-0.9. Normal controls are age-matched and have no risk factors for peripheral vascular disease. Fifteen patients with peripheral vascular disease and 30 healthy controls were collected. All subjects were supine and ligated with cuff tourniquet to achieve reactive hyperemia after ischemia. The subjects were scanned on 3.0T scanner. After scanning, 61 original ASL images were obtained. The peak value of perfusion was obtained from ROI at the maximum signal intensity on ASL blood flow chart, and the maximum blood flow value of soleus muscle was selected in this study. Perfusion measurements were performed between peripheral vascular disease patients and normal controls, while repetitive studies were performed by repeated measurements in 12 subjects (5 normal controls and 7 peripheral vascular disease patients). Results: the peak muscle perfusion (peak perfusion,PP) of 30 healthy controls (age, 52 鹵10 years) was 61 鹵13 ml / min -100 g / g of peripheral vascular disease (age: 63 鹵9 years). The malleolus brachial index (PP) was 37 鹵9 ml / min ~ (-100 g), which was significantly higher in the healthy control group than in the peripheral vascular disease patients. The results of T test of two independent samples show that 95% confidence interval is not over 0. We can think that the difference of mean value between two groups of data is statistically significant, as a result of repeatable measurement design, The intragroup correlation coefficient (intraclass correlation coefficient ICC) of 12 subjects before and after measurement was 0.94 (95% confidence interval 95%confidence interval [CI]: 0.80-0.98). The correlation coefficient between two observers in 45 subjects was 0.98 (95% confidence interval [CI]: 0.96-0.99). Conclusion: arterial spin labeling is a reproducible non-traumatic technique for measuring leg muscle perfusion. Arterial spin labeling can distinguish normal people from patients with peripheral vascular disease. The technology will confirm its role in improving clinical treatment of muscle perfusion, especially in patients who cannot accept gadolinium contrast.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R543.5
[Abstract]:Objective: this study hypothesized that arterial spin-labeled magnetic resonance imaging would be a reliable and noninvasive technique for measuring blood perfusion in healthy volunteers and patients with peripheral vascular disease before and after ligation of the leg muscles on a 3.0T scanner. And the two groups will be distinguished. Previous studies have confirmed the usefulness of the first-pass effect of gadolinium contrast agents in the measurement of leg muscle perfusion in patients with peripheral angiopathy. However, patients with peripheral vascular disease usually have progressive kidney disease, so gadolinium contrast agents are not acceptable. One advantage of using arterial spin labeling to measure leg muscle perfusion is the use of gadolinium contrast agents. Methods: the features of peripheral vascular disease were claudication, ankle brachial index (malleolus index) 0.4-0.9. Normal controls are age-matched and have no risk factors for peripheral vascular disease. Fifteen patients with peripheral vascular disease and 30 healthy controls were collected. All subjects were supine and ligated with cuff tourniquet to achieve reactive hyperemia after ischemia. The subjects were scanned on 3.0T scanner. After scanning, 61 original ASL images were obtained. The peak value of perfusion was obtained from ROI at the maximum signal intensity on ASL blood flow chart, and the maximum blood flow value of soleus muscle was selected in this study. Perfusion measurements were performed between peripheral vascular disease patients and normal controls, while repetitive studies were performed by repeated measurements in 12 subjects (5 normal controls and 7 peripheral vascular disease patients). Results: the peak muscle perfusion (peak perfusion,PP) of 30 healthy controls (age, 52 鹵10 years) was 61 鹵13 ml / min -100 g / g of peripheral vascular disease (age: 63 鹵9 years). The malleolus brachial index (PP) was 37 鹵9 ml / min ~ (-100 g), which was significantly higher in the healthy control group than in the peripheral vascular disease patients. The results of T test of two independent samples show that 95% confidence interval is not over 0. We can think that the difference of mean value between two groups of data is statistically significant, as a result of repeatable measurement design, The intragroup correlation coefficient (intraclass correlation coefficient ICC) of 12 subjects before and after measurement was 0.94 (95% confidence interval 95%confidence interval [CI]: 0.80-0.98). The correlation coefficient between two observers in 45 subjects was 0.98 (95% confidence interval [CI]: 0.96-0.99). Conclusion: arterial spin labeling is a reproducible non-traumatic technique for measuring leg muscle perfusion. Arterial spin labeling can distinguish normal people from patients with peripheral vascular disease. The technology will confirm its role in improving clinical treatment of muscle perfusion, especially in patients who cannot accept gadolinium contrast.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R543.5
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