Noguchi T, Irie H, Takase Y, Kawashima M, Ootsuka T, Nishihara M, Egashira Y, Nojiri J, Matsushima T, Kudo S
Department of Radiology, Faculty of Medicine, Saga University; Nabeshima, Saga, Japan.
Interv Neuroradiol. 2010 Dec;16(4):409-19. doi: 10.1177/159101991001600407. Epub 2010 Dec 17.
Arterial spin-labeling (ASL) magnetic resonance imaging (MRI) enables non-invasive acquisition of the brain perfusion information in cerebrovascular disease. We investigated hemodynamic changes in intracranial dural arteriovenous fistulas (DAVFs) using ASL-MRI. ASL-MRI by a Q2TIPS sequence on a 3.0-Tesla MRI was performed for three patients with Cognard's IIa+b type of DAVFs before and after treatment. Perfusion images obtained by ASL-MRI (ASL images) before treatment were visually compared with those by single-photon emission computed tomography images (SPECT images). Increasing rates of temporal changes of regional perfusion values in ASL images (ASL values) before and after treatment were also calculated. In all three patients, ASL images before treatment demonstrated high perfusion in regions around the shunting areas, where normal or low perfusion were detected on SPECT images; thus, ASL images might have demonstrated the abundant arterial shunting flow via the fistulas. On days eight to 20 after treatment, ASL values around the shunt areas remained the same or decreased, and those in the regions other than the shunt areas increased in all three patients. This might have been due to a combination of the following: a decrease in shunt flow volume, an amelioration of venous congestion, and a sustained an upward shift in the autoregulation of the brain perfusion pressure. All regional ASL values decreased on days 112 and 120 after treatment in two patients, which possibly reflects a reduction in the upward shift in autoregulation. ASL-MRI might be useful for identifying the hemodynamic behavior of DAVFs before and after treatment.
动脉自旋标记（ASL）磁共振成像（MRI）能够在不进行侵入性操作的情况下获取脑血管疾病中的脑灌注信息。我们使用ASL-MRI研究了颅内硬脑膜动静脉瘘（DAVF）的血流动力学变化。对3例Cognard IIa+b型DAVF患者在治疗前后采用3.0特斯拉MRI上的Q2TIPS序列进行ASL-MRI检查。将治疗前通过ASL-MRI获得的灌注图像（ASL图像）与单光子发射计算机断层扫描图像（SPECT图像）进行视觉比较。还计算了治疗前后ASL图像（ASL值）中区域灌注值的时间变化增加率。在所有3例患者中，治疗前的ASL图像显示分流区域周围灌注较高，而在SPECT图像上检测到的是正常或低灌注；因此，ASL图像可能显示了通过瘘管的丰富动脉分流。在治疗后的第8至20天，所有3例患者分流区域周围的ASL值保持不变或下降，而分流区域以外区域的ASL值升高。这可能是由于以下因素共同作用的结果：分流流量减少、静脉淤血改善以及脑灌注压自动调节持续向上偏移。在两名患者治疗后的第112天和120天，所有区域的ASL值均下降，这可能反映了自动调节向上偏移的减少。ASL-MRI可能有助于识别DAVF治疗前后的血流动力学行为。
