短期和长期 MRI 评估儿童烟雾病患者血运重建后的血流动力学变化。
Short- and Long-Term MRI Assessed Hemodynamic Changes in Pediatric Moyamoya Patients After Revascularization.
机构信息
Department of Radiology, Stanford University, Stanford, California, USA.
Department of Neuroradiology, Hospital Beatriz Ângelo, Lisbon, Portugal.
出版信息
J Magn Reson Imaging. 2024 Apr;59(4):1349-1357. doi: 10.1002/jmri.28902. Epub 2023 Jul 29.
BACKGROUND
Cerebrovascular reserve (CVR) reflects the capacity of cerebral blood flow (CBF) to change following a vasodilation challenge. Decreased CVR is associated with a higher stroke risk in patients with cerebrovascular diseases. While revascularization can improve CVR and reduce this risk in adult patients with vasculopathy such as those with Moyamoya disease, its impact on hemodynamics in pediatric patients remains to be elucidated. Arterial spin labeling (ASL) is a quantitative MRI technique that can measure CBF, CVR, and arterial transit time (ATT) non-invasively.
PURPOSE
To investigate the short- and long-term changes in hemodynamics after bypass surgeries in patients with Moyamoya disease.
STUDY TYPE
Longitudinal.
POPULATION
Forty-six patients (11 months-18 years, 28 females) with Moyamoya disease.
FIELD STRENGTH/SEQUENCE: 3-T, single- and multi-delay ASL, T1-weighted, T2-FLAIR, 3D MRA.
ASSESSMENT
Imaging was performed 2 weeks before and 1 week and 6 months after surgical intervention. Acetazolamide was employed to induce vasodilation during the imaging procedure. CBF and ATT were measured by fitting the ASL data to the general kinetic model. CVR was computed as the percentage change in CBF. The mean CBF, ATT, and CVR values were measured in the regions affected by vasculopathy.
STATISTICAL TESTS
Pre- and post-revascularization CVR, CBF, and ATT were compared for different regions of the brain. P-values <0.05 were considered statistically significant.
RESULTS
ASL-derived CBF in flow territories affected by vasculopathy significantly increased after bypass by 41 ± 31% within a week. At 6 months, CBF significantly increased by 51 ± 34%, CVR increased by 68 ± 33%, and ATT was significantly reduced by 6.6 ± 2.9%.
DATA CONCLUSION
There may be short- and long-term improvement in the hemodynamic parameters of pediatric Moyamoya patients after bypass surgery.
EVIDENCE LEVEL
4 TECHNICAL EFFICACY: Stage 2.
背景
脑血管储备（CVR）反映了脑血流（CBF）在血管扩张挑战后的变化能力。CVR 降低与脑血管疾病患者的更高中风风险相关。虽然血管重建可以改善成人血管病变患者（如烟雾病患者）的 CVR 并降低这种风险，但它对儿科患者的血流动力学的影响仍有待阐明。动脉自旋标记（ASL）是一种可以无创测量 CBF、CVR 和动脉传输时间（ATT）的定量 MRI 技术。
目的
研究烟雾病患者旁路手术后短期和长期的血流动力学变化。
研究类型
纵向研究。
人群
46 名烟雾病患者（11 个月至 18 岁，28 名女性）。
场强/序列：3T，单延迟和多延迟 ASL、T1 加权、T2-FLAIR、3D MRA。
评估
在手术干预前 2 周、1 周和 6 个月进行影像学检查。在成像过程中使用乙酰唑胺诱导血管扩张。通过将 ASL 数据拟合到一般动力学模型来测量 CBF 和 ATT。CVR 计算为 CBF 的百分比变化。在受血管病变影响的区域测量平均 CBF、ATT 和 CVR 值。
统计学检验
比较不同脑区再血管化前后的 CVR、CBF 和 ATT。P 值<0.05 被认为具有统计学意义。
结果
血管病变受累血流区的 ASL 衍生 CBF 在一周内通过旁路显著增加了 41±31%。6 个月时，CBF 显著增加 51±34%，CVR 增加 68±33%，ATT 显著降低 6.6±2.9%。
数据结论
旁路手术后，儿科烟雾病患者的血流动力学参数可能会出现短期和长期改善。
证据水平
4 级技术功效：2 级。
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