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目的探讨脑磁共振灌注成像(perfusion-weighted imaging,PWI)对于大脑中动脉狭窄患者的临床运用价值。方法选取本院2013年1月~2014年1月神经内科经颅内数字减影血管造影(Digital subtraction angiography,DSA)诊断为单侧大脑中动脉(middle cerebral artery,MCA)狭窄或闭塞的35例患者,并行脑磁共振灌注成像(Perfusion Weighted Imaging,PWI)检查,并对不同程度MCA狭窄状态下患侧和健侧大脑半球的脑灌注参数局部脑血容量(r CBV)、局部脑血流量(r CBF)、局部平均通过时间(r MTT)、局部达峰时间(r TTP)进行定性与定量分析。结果 35例患者中DSA诊断单侧MCA轻中度狭窄15例,其中脑灌注异常12例,患侧大脑半球r TTP较健侧显著延长(P<0.05);MCA重度狭窄或闭塞的20例患者中PWI检测均出现灌注异常,患侧大脑半球r TTP与r MTT均较健侧显著延长(P<0.05),而患侧r CBF较健侧明显减少(P<0.05)。结论磁共振PWI能较准确评估MCA狭窄程度和脑组织血供情况,可为临床诊断与治疗提供重要价值。
Objective To investigate the clinical value of perfusion-weighted imaging (PWI) in patients with middle cerebral artery stenosis. Methods 35 patients with unilateral middle cerebral artery (MCA) stenosis or occlusion were diagnosed by digital subtraction angiography (DSA) from January 2013 to January 2014 in our department of neurology. (P <0.05). Peripheral cerebral blood volume (r CBV) and local cerebral blood flow (P <0.05) were also measured in cerebral perfusion parameters of ipsilateral and contralateral hemispheres at different degrees of MCA stenosis. r CBF), local mean transit time (r MTT) and local peak time (r TTP) were used for qualitative and quantitative analysis. Results Among the 35 patients, DSA was diagnosed in 15 patients with mild or moderate unilateral MCA. Among them, 12 were abnormal cerebral perfusion and the rTTP in the ipsilateral hemisphere was significantly longer than that in the contralateral (P <0.05). Twenty patients with MCA severe stenosis or occlusion The perfusion abnormalities were detected in PWI. The rTTP and r MTT in affected hemisphere were significantly prolonged (P <0.05), while the r CBF in affected ipsilateral hemisphere was significantly lower than that in uninjured side (P <0.05). Conclusion Magnetic resonance PWI can accurately evaluate the degree of MCA stenosis and blood supply to brain tissue, which may provide important value for clinical diagnosis and treatment.