Wang Z, Bogdan A R, Zimmerman R A, Gusnard D A, Leigh J S, Ohene-Frempong K
Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania.
Neuroradiology. 1992;35(1):57-65. doi: 10.1007/BF00588281.
Localized proton nuclear magnetic resonance spectroscopy (MRS), obtained with stimulated echo and spin echo sequences, MR imaging (MRI) and MR angiography (MRA) were used to study the brain in 13 children and adolescents with sickle cell disease. Regions of interest (ROI) studied by MRS included regions appearing normal on MRI as well as regions showing complications of sickle cell disease, including focal deep white matter areas of high signal intensity (deep white matter ischemia, DWMI) seen on long TR images, focal atrophic brain areas, and infarcts. The findings in these studies are summarized as follows: Normal-appearing regions on MRI have normal MRS. In ROI including small areas of DWMI, lactate elevation was not detected, but the levels of N-acetyl-aspartate (NAA) appeared slightly elevated. In areas of DWMI 1-2 cm in size, reduced blood flow could be seen on MRA and lactate elevation could be detected with MRS. When blood flow to a DWMI region was normal, NAA was reduced and there was little lactate elevation, as cell death had already occurred. ROI consisting of atrophic tissue had reduced NAA levels but total creatine levels were not changed. Sometimes lipids, presumably from broken cell membrane, could be detected. In regions of past massive stroke, all metabolites were absent except for small amounts of lactate or lipids.
采用刺激回波和自旋回波序列进行局部质子核磁共振波谱（MRS）检查，并结合磁共振成像（MRI）和磁共振血管造影（MRA），对13例镰状细胞病患儿及青少年的脑部进行研究。MRS检查的感兴趣区域（ROI）包括MRI上显示正常的区域以及显示镰状细胞病并发症的区域，包括长TR图像上可见的局灶性深部白质高信号区（深部白质缺血，DWMI）、局灶性脑萎缩区域和梗死灶。这些研究结果总结如下：MRI上显示正常的区域MRS也正常。在包含小面积DWMI的ROI中，未检测到乳酸升高，但N-乙酰天门冬氨酸（NAA）水平似乎略有升高。在大小为1-2厘米的DWMI区域，MRA上可见血流减少，MRS可检测到乳酸升高。当DWMI区域的血流正常时，NAA降低且乳酸升高不明显，因为细胞死亡已经发生。由萎缩组织构成的ROI中NAA水平降低，但总肌酸水平未改变。有时可检测到可能来自破裂细胞膜的脂质。在既往大面积脑梗死区域，除少量乳酸或脂质外，所有代谢物均缺失。
