摘要
目的:运用动态对比增强磁共振成像(DCE-MR1)结合动脉自旋标记(ASL)多参数评估血脑屏障(BBB)通透性变化及预测出血转化(HT)的发生。方法:纳入2019年5月至2019年12月我院收治的急性及亚急性缺血性脑卒中患者共计39例,进行DCE-MRI及ASL扫描,图像经计算后处理获得药代动力学参数(K^(trans)、Kep、Ve、Vp),评估BBB渗透性变化,分析其与HT之间的相关性。结果:39例入组患者中,7例(17.95%)发生HT,HT发生组rK^(trans)值、患侧K^(trans)值均较未发生组明显增高(P=0.044,P=0.045)。患侧K^(trans)区分HT的阈值为0.019min^(-1)(灵敏度100%,特异度81.2%,P<0.001);K^(trans)区分HT的阈值为3.21(灵敏度85.7%,特异度93.7%,P=O.004)。高灌注组患侧K^(trans)、患侧Ve、患侧Vp、rK^(trans)、rVe均较非高灌注组明显增高。结论:DCE-MRI所获得的多参数能评估BBB渗透性改变,患侧K^(trans)及rK^(trans)可以作为预测HT的影像学标志物。同时,缺血性脑卒中发生高灌注改变者BBB遭受的破坏更为严重。
Purpose:Dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)combined with arterial spin labeling(ASL)were used to evaluate the dynamic evolution of blood-brain barrier(BBB)permeability,and the ability and feasibility of BBB permeability to predict haemorrhagic transformation(HT)was also discussed.Methods:From May 2019 to December 2019,39 cases of acute and subacute ischemic stroke were enrolled,and DCE and ASL imaging were performed.The pharmacokinetic parameters of DCE-MRI were obtained by postprocessing,such as volume transfer constant(K^(trans)),interstitium-to-plasma rate constant(Kep),fractional extracellular space volume(Ve),and fractional plasma volume(Vp).The BBB permeability was evaluated by multi parameters of DCE imaging,and the correlation between these parameters and the incidence of HT was analyzed.Results:A total of 39 cases were included in the statistical analysis,of which 7 cases(17.95%)had diagnosis of HT.Both the relative Ktrans(rk^(trans))and the ipsilateral K^(trans) in the HT group were significantly higher than that in the non-HT group(P=0.044,p=0.045).The threshold value of K^(trans) and rK^(trans) was 0.019 min1(100% sensitivity,81.2% specificity,P<0.001)and 3.21(85.7% sensitivity,93.7% specificity,P=0.004)respectively.The BBB parameters,such as K^(trans),Ve,Vp of ipsilateral,rK^(trans) and rVe in hyperperfusion group were significantly higher than that in non-hyperperfusion group.Conclusion:The multi parameters obtained by DCE-MRI can evaluate the permeability of BBB.and rK^(trans) can be used as imaging markers to predict HT.At the same time,the damage of BBB is more serious in ischemic stroke patients with hyperperfiision.
作者
潘莉君
王娟
赵一旭
王丽
俎金燕
李杨
李磊
周斌
陈增爱
PAN Lijun;WANG Juan;ZHAO Yixu;WANG Li;ZU Jinyan;LI Yang;LI Lei;ZHOU Bin;CHEN Zeng'ai(Department of Radiology,Renji Hospital East Campus,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Radiology,Renji Hospital South Campus,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)
出处
《中国医学计算机成像杂志》
CSCD
北大核心
2021年第3期199-203,共5页
Chinese Computed Medical Imaging
基金
上海市科委西医引导项目(19411971200)
上海市卫生和计划生育委员会青年课题(20174Y0050)
上海交通大学医学院附属仁济医院南院国家自然科学基金培育项目(2017PYQB04)及博士专项(2019NYBSZX02)。
关键词
急性缺血性脑卒中
动脉自旋标记
动态对比增强磁共振成像
出血转化
高灌注
血脑屏障
Acute ischemic stroke
Arterial spin labeling
Dynamic contrast-enhanced magnetic resonance imaging
Hemorrhagic transformation
Hyperperfusion
Blood-brain barrier
