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目的采用动脉自旋标记(ASL)检测蛛网膜下腔出血术后的症状半球。方法研究包括18例动脉瘤所致蛛网膜下腔出血的病人,4例术后出现症状性血管痉挛。全部病人在第9～10天进行ASL检查(单次ASL)。9例病人分别在第1～2天、9～10天和13～21天进行连续ASL检查(连续ASL),7例病人在第4～7天也进行了检查。测量大脑中动脉供血区后部的脑血流量(CBF),估算同侧/对侧的CBF比例。通过受试者操作特征(ROC)曲线分析症状半球和其他部位之间的差异。结果单次ASL显示,CBF第9～10天和CBF同侧/对侧第9～10天在症状半球明显低于非症状半球(P<0.001)。连续ASL显示,CBF第4～7天较CBF第1～2天明显降低,CBF第9～10天较CBF第4～7天明显降低,而CBF第13～21天较CBF第9～10天明显升高。单次ASL的ROC分析显示CBF第9～10天的曲线下面积为0.95,明显高于CBF同侧/对侧第9～10天(P<0.001)。连续ASL的ROC分析显示CBF第9～10天的曲线下面积为0.93,明显高于CBF第9～10天/第1～2天和CBF同侧/对侧第9～10天(P<0.001)。结论单次ASL显示症状半球较非症状半球CBF明显减低。连续ASL可显示蛛网膜下腔出血后CBF随时间的变化。
Objective To detect the symptom hemisphere after subarachnoid hemorrhage by arterial spin labeling (ASL). Methods Study included 18 patients with subarachnoid hemorrhage caused by aneurysm and 4 patients with symptomatic vasospasm after operation. All patients underwent ASL on day 9 to 10 (single ASL). Nine patients underwent continuous ASL (consecutive ASL) at days 1 to 2, 9 to 10, and 13 to 21, respectively. Seven patients were also examined on days 4 to 7. Cerebral blood flow (CBF) was measured at the posterior part of the middle cerebral artery and the ipsilateral / contralateral CBF was estimated. Differences between the symptom hemisphere and other sites were analyzed by receiver operating characteristic (ROC) curves. Results A single ASL showed significantly lower hemispheric symptoms than non-symptomatic hemispheres (P <0.001) on the 9th to 10th days of CBF and ipsilateral / contralateral CBF on days 9-10. Continuous ASL showed that the 4th to 7th days of CBF were significantly lower than the 1st to 2nd days of CBF, the CBF was significantly lower on the 9th to 10th days than the 4th to 7th days of CBF, while the CBF was lower on the 9th to 10th days than the CBF on the 13th to 21st days Significantly increased. ROC analysis of a single ASL showed that the area under the curve for CBF from day 9 to day 10 was 0.95, significantly higher than the ipsilateral / contralateral sides of CBF for days 9 to 10 (P <0.001). ROC analysis of consecutive ASLs showed that the area under the curve for CBF from day 9 to 10 was 0.93, significantly higher than CBF 9 to 10 / day 1-2 and CBF ipsilateral / contralateral day 9-10 (P <0.001 ). Conclusions A single ASL showed a significant reduction of symptoms in the hemisphere compared with non-symptomatic hemisphere CBF. Continuous ASL shows CBF changes over time following subarachnoid hemorrhage.