3.0 T磁共振三维准连续动脉自旋标记成像对肝性脑病应用价值初探
|
摘要
目的分析肝性脑病(HE)患者脑血流量(CBF)的变化并探讨灌注模式。方法搜集20例经临床检查证实的HE患者和20名健康志愿者纳入本研究,采用3.0 T MRI进行三维准连续动脉自旋标记(3D-pCASL)灌注成像扫描,统计分析患者组(HE组)与正常对照组的脑灌注差异。结果 HE组右侧尾状核头、苍白球、壳核、丘脑、扣带回CBF值分别为(55.65±16.40)、(38.63±7.62)、(52.22±9.77)、(61.31±14.05)、(82.32±16.27)ml·100g~(-1)·min~(-1),左侧尾状核头、苍白球、壳核、丘脑、扣带回CBF值分别为(56.14±17.20)、(36.89±7.94)、(49.54±10.29)、(65.32±13.76)、(84.91±17.39)ml·100g~(-1)·min~(-1),中脑及脑桥CBF值为(48.62±11.23)、(52.43±9.10)ml·100g~(-1)·min~(-1);对照组右侧尾状核头、苍白球、壳核、丘脑、扣带回CBF值分别为(56.46±5.98)、(36.41±4.76)、(45.88±5.88)、(50.27±7.42)、(51.59±6.06)ml·100g~(-1)·min~(-1),左侧尾状核头、苍白球、壳核、丘脑、扣带回CBF值分别为(57.11±9.04)、(34.08±3.92)、(45.65±7.71)、(53.40±7.79)、(55.90±8.08)ml·100g~(-1)·min~(-1),中脑及脑桥CBF值为(42.68±7.18)、(41.21±5.91)ml·100g~(-1)·min~(-1)。与对照组比较,HE组双侧丘脑、扣带回及脑桥的CBF升高,差异均具有统计学意义(P<0.05),双侧尾状核头、苍白球、壳核及中脑的CBF差异无统计学意义(P>0.05)。尾状核头的CBF值与Child-Pugh评分相关(P<0.05),双侧苍白球、壳核、丘脑、扣带回、中脑及脑桥的CBF值均与Child-Pugh评分无关(P>0.05)。结论 3D-pCASL可定量评估HE患者的CBF,HE患者皮质功能不良,CBF由皮质向基底神经节重新分配。
Objective To analyse the changes of cerebral blood flow in patients with hepatic encephalopathy and investigate the perfusion pattern. Methods 20 patients with hepatic encephalopathy proven by clinical examinations and 20 healthy volunteers have been investigated. Underwent perfusion imaging with three-dimensional pseudo-continuous arterial spin labeling using 3.0 T MR.The differences of perfusion between the patient group and the normal control group were statistically analyzed. Results The cerebral blood flow of the caudate nucleus,globus pallidus,putamen,thalamus and cingulate gyrus in the right side of the HE group were 55.65±16.40,38.63±7.62,52.22±9.77,61.31±14.05 and 82.32±16.27(ml·100 g~(-1)·min~(-1)).The cerebral blood flow of the caudate nucleus,globus pallidus,putamen,thalamus and cingulate gyrus in the left side of the HE group were 56.14±17.20,36.89±7.94,49.54±10.29,65.32±13.76 and 84.91±17.39(ml·100 g~(-1)·min~(-1)).The cerebral blood flow of the mesencephalon and pontine of the HE group were 48.62±11.23 and 52.43±9.10(ml·100 g~(-1)·min~(-1)).The cerebral blood flow of the caudate nucleus,globus pallidus,putamen,thalamus and cingulate gyrus in the right side of the control group were 56.46±5.98、36.41±4.76、45.88±5.88、50.27±7.42 and 51.59±6.06(ml·100 g~(-1)·min~(-1)).The cerebral blood flow of the caudate nucleus,globus pallidus,putamen,thalamus and cingulate gyrus in the left side of the control group were 57.11±9.04、34.08±3.92、45.65±7.71、53.40±7.79 and 55.90±8.08(ml·100 g~(-1)·min~(-1)).The cerebral blood flow of the mesencephalon and pontine of the control group were 42.68±7.18 and 41.21±5.91(ml·100 g~(-1)·min~(-1)).The cerebral blood flow of bilateral thalamus,cingulate gyrus and pons increased in the HE group,the differences were statistically significant compared with the control group(P<0.05).There were no statistically significant differences in the cerebral blood flow of bilateral caudate nucleus,globus pallidus,putamen and midbrain(P>0.05).The CBF of the head of the caudate nucleus was related to the Child-Pugh score(P<0.05),the CBF of bilateral globus pallidus,putamen,thalamus,cingulate gyrus,midbrain and pons was not related to the Child-Pugh score(P>0.05). Conclusion The quantitative assessment was made for cerebral blood flow of hepatic encephalopathy patients by 3 D-pCASL.The cortical function of HE patients was poor,the cerebral blood flow was redistributed from the cortex to the basal ganglia.
Objective To analyse the changes of cerebral blood flow in patients with hepatic encephalopathy and investigate the perfusion pattern. Methods 20 patients with hepatic encephalopathy proven by clinical examinations and 20 healthy volunteers have been investigated. Underwent perfusion imaging with three-dimensional pseudo-continuous arterial spin labeling using 3.0 T MR.The differences of perfusion between the patient group and the normal control group were statistically analyzed. Results The cerebral blood flow of the caudate nucleus,globus pallidus,putamen,thalamus and cingulate gyrus in the right side of the HE group were 55.65±16.40,38.63±7.62,52.22±9.77,61.31±14.05 and 82.32±16.27(ml·100 g~(-1)·min~(-1)).The cerebral blood flow of the caudate nucleus,globus pallidus,putamen,thalamus and cingulate gyrus in the left side of the HE group were 56.14±17.20,36.89±7.94,49.54±10.29,65.32±13.76 and 84.91±17.39(ml·100 g~(-1)·min~(-1)).The cerebral blood flow of the mesencephalon and pontine of the HE group were 48.62±11.23 and 52.43±9.10(ml·100 g~(-1)·min~(-1)).The cerebral blood flow of the caudate nucleus,globus pallidus,putamen,thalamus and cingulate gyrus in the right side of the control group were 56.46±5.98、36.41±4.76、45.88±5.88、50.27±7.42 and 51.59±6.06(ml·100 g~(-1)·min~(-1)).The cerebral blood flow of the caudate nucleus,globus pallidus,putamen,thalamus and cingulate gyrus in the left side of the control group were 57.11±9.04、34.08±3.92、45.65±7.71、53.40±7.79 and 55.90±8.08(ml·100 g~(-1)·min~(-1)).The cerebral blood flow of the mesencephalon and pontine of the control group were 42.68±7.18 and 41.21±5.91(ml·100 g~(-1)·min~(-1)).The cerebral blood flow of bilateral thalamus,cingulate gyrus and pons increased in the HE group,the differences were statistically significant compared with the control group(P<0.05).There were no statistically significant differences in the cerebral blood flow of bilateral caudate nucleus,globus pallidus,putamen and midbrain(P>0.05).The CBF of the head of the caudate nucleus was related to the Child-Pugh score(P<0.05),the CBF of bilateral globus pallidus,putamen,thalamus,cingulate gyrus,midbrain and pons was not related to the Child-Pugh score(P>0.05). Conclusion The quantitative assessment was made for cerebral blood flow of hepatic encephalopathy patients by 3 D-pCASL.The cortical function of HE patients was poor,the cerebral blood flow was redistributed from the cortex to the basal ganglia.
引文
1 王峻瑶,刘玉兰.肝性脑病研究现状与展望[J].中华肝脏病杂志,2014,22:81-83.
2 中华医学会消化病学分会,中华医学会肝病学分会.中国肝性脑病诊治共识意见(2013年,重庆)[J].中华肝脏病杂志,2013,21:641-651.
3 Zheng G,Zhang LJ,Zhong J,et al.Cerebral blood flow measured by arterial-spin labeling MRI:A useful biomarker for characterization of minimal hepatic encephalopathy in patients with cirrhosis[J].Eur J Radiol,2013,82:1981-1988.
4 杨炯,韩盈,崔晓明,等.动脉自旋标记MRI脑血流灌注成像在亚临床期肝性脑病患者的研究[J].医学影像学志,2012,22:1993-1996.
5 Zhang XD,Zhang LJ,Wu SY,et al.Multimodality magnetic resonance imaging in hepatic encephalopathy:an update[J].World J Gastroenterol,2014,20:11262-11272.
6 Catafau AM,Kulisevsky J,Bernà L,et al.Relationship between cerebral perfusion in frontal-limbic-basal ganglia circuits and neuropsychologic impairment in patients with subclinical hepatic encephalopathy[J].J Nucl Med,2000,41:405-410.
7 Iwasa M,Kaito M,Adachi Y,et al.Cerebral blood flow in basal ganglia is correlated with clinical signs of hepatic encephalopathy in patients with liver cirrhosis[J].Am J Gastroenterol,2002,97:763-764
8 Jalan R,Olde Damink SWM,Lui HF,et al.Oral amino acid load mimicking hemoglobin results in reduced regional cerebral perfusion and deterioration in memory tests in patients with cirrhosis of the liver[J].Metab Brain Dis,2003,18:37-49.
9 Zheng G,Zhang LJ,Cao Y,et al.Venousbloodammonia can be associated with cerebral blood flow in hepatic encephalopathy[J].Hepatology,2013,58:832-833.
10 王宇明,晏泽辉.肝性脑病诊断治疗新认识[J].临床肝胆病杂志,2010,26:568-574.
2 中华医学会消化病学分会,中华医学会肝病学分会.中国肝性脑病诊治共识意见(2013年,重庆)[J].中华肝脏病杂志,2013,21:641-651.
3 Zheng G,Zhang LJ,Zhong J,et al.Cerebral blood flow measured by arterial-spin labeling MRI:A useful biomarker for characterization of minimal hepatic encephalopathy in patients with cirrhosis[J].Eur J Radiol,2013,82:1981-1988.
4 杨炯,韩盈,崔晓明,等.动脉自旋标记MRI脑血流灌注成像在亚临床期肝性脑病患者的研究[J].医学影像学志,2012,22:1993-1996.
5 Zhang XD,Zhang LJ,Wu SY,et al.Multimodality magnetic resonance imaging in hepatic encephalopathy:an update[J].World J Gastroenterol,2014,20:11262-11272.
6 Catafau AM,Kulisevsky J,Bernà L,et al.Relationship between cerebral perfusion in frontal-limbic-basal ganglia circuits and neuropsychologic impairment in patients with subclinical hepatic encephalopathy[J].J Nucl Med,2000,41:405-410.
7 Iwasa M,Kaito M,Adachi Y,et al.Cerebral blood flow in basal ganglia is correlated with clinical signs of hepatic encephalopathy in patients with liver cirrhosis[J].Am J Gastroenterol,2002,97:763-764
8 Jalan R,Olde Damink SWM,Lui HF,et al.Oral amino acid load mimicking hemoglobin results in reduced regional cerebral perfusion and deterioration in memory tests in patients with cirrhosis of the liver[J].Metab Brain Dis,2003,18:37-49.
9 Zheng G,Zhang LJ,Cao Y,et al.Venousbloodammonia can be associated with cerebral blood flow in hepatic encephalopathy[J].Hepatology,2013,58:832-833.
10 王宇明,晏泽辉.肝性脑病诊断治疗新认识[J].临床肝胆病杂志,2010,26:568-574.