症状性颈动脉狭窄：基于动脉自旋标记 MRI 测量脑组织水平的脑自动调节功能障碍。

Symptomatic carotid artery stenosis: impairment of cerebral autoregulation measured at the brain tissue level with arterial spin-labeling MR imaging.

机构信息

Department of Radiology, University Medical Center Utrecht, HP E.01.132, Heidelberglaan 100, Utrecht, the Netherlands.

出版信息

Radiology. 2010 Jul;256(1):201-8. doi: 10.1148/radiol.10091262.

DOI:10.1148/radiol.10091262

PMID:20574097

Abstract

PURPOSE

To measure the cerebral autoregulatory status of the brain tissue supplied by the individual brain-feeding arteries in patients with symptomatic stenosis of the internal carotid artery (ICA) by using arterial spin-labeling (ASL) magnetic resonance (MR) imaging and to compare this status with that in healthy controls.

MATERIALS AND METHODS

Institutional review board approval and informed consent were obtained. Twenty-three patients (mean age, 69.3 years +/- 8.0 [standard deviation]) with unilateral symptomatic stenosis of the ICA and 20 healthy controls (mean age, 66.8 years +/- 6.3 [standard deviation]) underwent perfusion and flow territory-selective ASL MR imaging before and after intravenous administration of acetazolamide. Cerebrovascular reactivity was measured throughout the brain in the gray matter that is supplied by the individual ICAs and the basilar artery. Data were analyzed with paired and unpaired t tests.

RESULTS

In patients with symptomatic stenosis of the ICA, the flow territory of the symptomatic ICA was smaller than that of the asymptomatic ICA. After administration of acetazolamide, a significant increase in cerebral blood flow at the brain tissue level was measured in both control subjects and patients in all perfusion territories. Mean cerebrovascular reactivity values were 35.9% +/- 3.0% (standard error) and 44.6% +/- 3.5% (standard error) in the flow territories of the patients with symptomatic ICAs and those with asymptomatic ICAs, respectively, and 47.9% +/- 3.1% (standard error) in the control subjects. Cerebrovascular reactivity was lower in the flow territory of the symptomatic ICA than in the arteries of control participants (mean difference, -12.0%; 95% confidence interval: -20.7%, -3.3%).

CONCLUSION

In patients with symptomatic stenosis of the ICA, vasodilatory capacity in the flow territories of the major cerebral arteries can be visualized and quantified at the brain tissue level with ASL MR imaging.

摘要

目的

使用动脉自旋标记（ASL）磁共振成像（MR）测量有症状的颈内动脉（ICA）狭窄患者由各脑供血动脉供应的脑组织的脑自动调节状态，并与健康对照者进行比较。

材料与方法

本研究获得了机构审查委员会批准和患者知情同意。23 例单侧有症状 ICA 狭窄患者（平均年龄，69.3 岁±8.0[标准差]）和 20 名健康对照者（平均年龄，66.8 岁±6.3[标准差]）在静脉注射乙酰唑胺前后进行了灌注和血流区域选择性 ASL MR 成像。在由各 ICA 和基底动脉供应的灰质中测量了整个脑的脑血管反应性。采用配对和非配对 t 检验对数据进行分析。

结果

在有症状的 ICA 狭窄患者中，症状性 ICA 的血流区域小于无症状性 ICA。乙酰唑胺给药后，在所有灌注区域，对照组和患者的脑实质水平的脑血流均有显著增加。在有症状 ICA 和无症状 ICA 的血流区域，平均脑血管反应性值分别为 35.9%±3.0%（标准误差）和 44.6%±3.5%（标准误差），而对照组为 47.9%±3.1%（标准误差）。症状性 ICA 的血流区域的脑血管反应性低于对照组参与者的动脉（平均差值，-12.0%；95%置信区间：-20.7%，-3.3%）。