Jia Rui, Xu Xian, Liu Xinqiu, Wu Bing, Men Weiwei, An Ningyu
1 Department of Radiology of South Building,Chinese PLA General Hospital,Beijing 100853,China.
2 Department of MRI,GE Healthcare,Beijing 100176,China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2017 Apr 20;39(2):272-279. doi: 10.3881/j.issn.1000-503X.2017.02.018.
Objective To investigate the value of 3D pseudo-continuous arterial spin labeling (3D-pCASL) magnetic resonance perfusion technique in evaluating posterior circulation ischemia (PCI) of the elderly beyond 80 years old and to offer the evidence of PCI of the elderly for clinical diagnosis. Methods Totally 53 male subjects older than 80 years were recruited in this study,including 20 subjects with clinically diagnosed PCI and 33 normal subjects. All the subjects underwent routine brain magnetic resonance imaging and 3D-pCASL sequence on a 3.0T magnetic resonance imaging system with 8 channel brain coil. Two post-labeling delay (PLD) time (PLD=1525 ms and PLD=2525 ms) of 3D-pCASL were used in this study to increase the accuracy of cerebral blood flow (CBF) change of posterior circulation region. We used SPM12 software to measure mean CBF values of bilateral occipital lobes and bilateral cerebellums. Independent sample t-test and rank-sum test were performed to evaluate the difference of CBF changes of anterior circulation and posterior circulation in two groups at two PLD time,the difference of CBF changes of bilateral occipital lobes and bilateral cerebellums in two groups of two PLD time,and the difference of increment of CBF between two PLD interval between two groups. Results In case group,the CBF value of the anterior circulation was significantly higher than that of posterior circulation at both two PLD time points (PLD=1525 ms and PLD=2525 ms)(P=0.000,P=0.000);in control group,the CBF value of the anterior circulation was significantly higher than that of the posterior circulation only at PLD=1525ms (P=0.025). The CBF values at bilateral occipital lobes and bilateral cerebellums at two PLD time points (PLD=1525 ms and PLD=2525 ms) were significantly higher in case group than in control group(P=0.003,P=0.002,P=0.000,P=0.001,P=0.000,P=0.001,P=0.002,P=0.014,respectively). Compared with the control group,the difference was statistically significant in bilateral occipital lobes and cerebellums with a smaller △CBF between two PLD interval in case group (P=0.004,P=0.001,P=0.001,P=0.025). Conclusion Multiple PLD time points need to be used in 3D-pCASL in diagnosing PCI of the elderly because the posterior circulation is slow in these patients. 3D-pCASL technique is sensitive in detecting decreased CBF in posterior circulation and therefore can be used to predict posterior circulation stroke in the elderly.
目的 探讨三维伪连续动脉自旋标记（3D-pCASL）磁共振灌注技术在评估80岁以上老年人后循环缺血（PCI）中的价值，为老年人PCI的临床诊断提供依据。方法 本研究共纳入53例80岁以上男性受试者，其中临床诊断为PCI的受试者20例，正常受试者33例。所有受试者均在3.0T磁共振成像系统上，采用8通道头部线圈行常规脑磁共振成像及3D-pCASL序列检查。本研究采用两个后标记延迟（PLD）时间（PLD = 1525 ms和PLD = 2525 ms）的3D-pCASL，以提高后循环区域脑血流量（CBF）变化的准确性。采用SPM12软件测量双侧枕叶和双侧小脑的平均CBF值。采用独立样本t检验和秩和检验，分别评估两组在两个PLD时间点前循环与后循环CBF变化的差异、两组在两个PLD时间点双侧枕叶和双侧小脑CBF变化的差异以及两组两个PLD间隔之间CBF增量的差异。结果 在病例组中，两个PLD时间点（PLD = 1525 ms和PLD = 2525 ms）前循环的CBF值均显著高于后循环（P = 0.000，P = 0.000）；在对照组中，仅在PLD = 1525 ms时前循环的CBF值显著高于后循环（P = 0.025）。病例组在两个PLD时间点（PLD = 1525 ms和PLD = 2525 ms）双侧枕叶和双侧小脑的CBF值均显著高于对照组（分别为P = 0.003，P = 0.002，P = 0.000，P = 0.001，P = 0.000，P = 0.001，P = 0.002，P = 0.014）。与对照组相比，病例组两个PLD间隔之间△CBF较小的双侧枕叶和小脑差异有统计学意义（P = 0.004，P = 0.001，P = 0.001，P = 0.025）。结论 由于老年患者后循环血流缓慢，在诊断老年PCI时，3D-pCASL需要采用多个PLD时间点。3D-pCASL技术在检测后循环CBF降低方面具有敏感性，因此可用于预测老年患者后循环卒中。
