Labriffe Matthieu, Ter Minassian Aram, Pasco-Papon Anne, N'Guyen Sylvie, Aubé Christophe
EA7315, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS), Université d'Angers, Angers, France; Pôle d'Imagerie, CHU d'Angers, Angers, France.
EA7315, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS), Université d'Angers, Angers, France; Pôle d'Anesthésie Réanimation, CHU d'Angers, Angers, France.
J Neuroradiol. 2015 Dec;42(6):358-67. doi: 10.1016/j.neurad.2015.04.001. Epub 2015 Jun 3.
To evaluate the validity of pulsed arterial spin labeling (PASL) imaging with cerebral blood flow (CBF) quantification for monitoring subarachnoid hemorrhage (SAH); to describe changes in the perfusion signal in the absence of or following several classic complications.
Fifteen patients and 14 healthy volunteers were assigned to SAH and control populations, respectively. ASL imaging was performed three times: between Day 0 (D0, i.e., day of onset of SAH symptoms) and D3, between D7 and D9 and between D12 and D14. ASL points were classified as complicated (symptomatic vasospasm, intraparenchymal hematoma or severe intracranial hypertension) or uncomplicated. Perfusion and CBF maps were generated after automated processing. The inversion time (TI) was fixed at 1800 ms.
CBF mean value of Day0-3 uncomplicated SAH patients (47 ± 11.7 mL/min/100g) was significantly higher than that of the volunteers (36.5 ± 7.6 mL/min/100g; P=0.014). In a case-by-case analysis, we observed a global or regional hypoperfusion pattern when SAH was complicated by vasospasm or severe intracranial hypertension, particularly at the junctional areas. Furthermore, we have faced major vascular artefacts, visible as serpiginous high signals and related to the retention of labeled protons in arteries concerning by angiographic vasospasm.
PASL is an interesting perfusion technique to non-invasively highlight perfusion changes in complicated SAH and can provide a new element in the decision to perform urgent endovascular treatment. However, the increase in arterial transit time makes the Buxton quantification model inapplicable and leads to false high CBF values in the single-TI PASL technique.
评估采用脑血流量（CBF）定量的脉冲动脉自旋标记（PASL）成像监测蛛网膜下腔出血（SAH）的有效性；描述在无几种典型并发症或出现这些并发症后灌注信号的变化。
分别将15例患者和14名健康志愿者纳入SAH组和对照组。进行3次动脉自旋标记（ASL）成像：在第0天（D0，即SAH症状发作日）至第3天之间、第7天至第9天之间以及第12天至第14天之间。ASL点被分类为复杂（有症状的血管痉挛、脑实质内血肿或严重颅内高压）或不复杂。自动处理后生成灌注和CBF图。反转时间（TI）固定为1800毫秒。
第0天至第3天无并发症SAH患者的CBF平均值（47±11.7毫升/分钟/100克）显著高于志愿者（36.5±7.6毫升/分钟/100克；P=0.014）。在逐个病例分析中，我们观察到当SAH并发血管痉挛或严重颅内高压时，出现整体或局部灌注不足模式，特别是在交界区域。此外，我们遇到了主要的血管伪影，表现为蜿蜒的高信号，与血管造影显示血管痉挛的动脉中标记质子的滞留有关。
PASL是一种有趣的灌注技术，可无创地突出复杂SAH中的灌注变化，并可为决定是否进行紧急血管内治疗提供新的依据。然而，动脉通过时间的增加使得巴克斯顿定量模型不适用，并导致单TI PASL技术中出现CBF值假性升高。
