间位五分法测量脑血流量对成人烟雾病血流重建效果的评估价值研究

A Study of Evaluation Value of Meta-Quintile Measurement of Cerebral Blood Flow Volume on Blood Flow Reconstruction Effect in Adults with Moyamoya Disease

摘要: 目的：应用脑动脉血质子自旋标记磁共振灌注成像(MRI-ASL)进行大脑局部血流量定量测定，通过“间位五分法”计算单侧平均脑血流量，以评估烟雾病患者大脑血供情况以及联合脑血流重建术对烟雾病患者的脑血流重建效果。方法：采用回顾性研究，对22例入组烟雾病患者术前和术后的ASL检查结果进行分析。在半卵圆中心平面上围绕胼胝体画一半椭圆弧，在其上取五等分点，分别以第1，3，5点为圆心分别选取一兴趣区，用以代表大脑前动脉、大脑中动脉、大脑后动脉的供血区，通过图像处理获得相应脑血流量(CBF)计数资料，应用SPSS 26.0统计软件对所得数据进行分析，得出结论。结果：入组患者中有2例患者术侧3个兴趣区CBF均低于正常范围，3例患者术侧3个兴趣区中有2个CBF低于正常范围，8例患者术侧3个兴趣区中有1个CBF低于正常范围，而术侧3个兴趣区均不存在低CBF的患者仅有9例。根据入组烟雾病患者的术前mRS评分将患者分为(mRS评分为0~2)和重型(mRS评分3~6)两组，“轻型”患者CBF值(49.19 ± 9.45)高于“重型”患者(35.62 ± 12.24)，且差异有统计学意义(t = 2.938, P = 0.008)根据入组烟雾病患者的松岛分级将患者分为“预后欠佳组”(松岛分级0级或1级)和“预后良好组”(松岛分级2级或3级)两组，“预后欠佳组”患者ΔCBF和ΔnCBF值均低于“预后良好组”患者，且差异均具有统计学意义(ΔCBF: t=−2.213, P = 0.039; ΔnCBF: t = −3.079, P = 0.006)。结论：1) MRI-ASL可用于定量测定烟雾病患者局部脑血流量，可以用于评估局部脑血流动力学水平；2) 通过“间位五分法”测算的术前单侧平均脑血流量与烟雾病患者术前神经功能情况成正相关，对疾病严重程度的评估有参考价值；3) 通过“间位五分法”分别测算联合脑血流重建术前和术后的平均脑血流量并进行对比，可用于评估血运改善的效果，对预后的评估也有参考价值。

Abstract: Objective: To evaluate cerebral blood supply in patients with moyamoya disease and the effect of combined cerebral blood flow reconstruction surgery on cerebral blood flow reconstruction in pa-tients with moyamoya disease by means of meta-quintile measurement of cerebral blood flow by proton spin labeled magnetic resonance perfusion imaging (MRI-ASL). Methods: A retrospective study was conducted to analyze the preoperative and postoperative ASL results of 22 patients with moyamoya disease. Half of the elliptic arcs were drawn around the corpus callosum on the central plane of the semi-oval, and five equal points were selected on it. An area of interest was selected from the center of points 1, 3, and 5 to represent the blood supply areas of the anterior cerebral ar-tery, middle cerebral artery and posterior cerebral artery, respectively, and corresponding cerebral blood flow (CBF) data were obtained through image processing. SPSS 26.0 statistical software was used to analyze the data and draw a conclusion. Results: Among the enrolled patients, 2 patients had 3 lower CBF areas interest on the operative side, 3 patients had 2 lower CBF areas interest on the operative side, 8 patients had 1 lower CBF area of interest on the operative side, and only 9 pa-tients had no low CBF area of interest on the operative side. According to preoperative mRS scores of enrolled moyamoya disease patients, the patients were divided into two groups: (mRS score 0~2) and severe (mRS score 3~6). The CBF value of “light” patients (49.19 ± 9.45) was higher than that of “severe” patients (35.62 ± 12.24), and the difference was statistically significant (t = 2.938, P = 0.008). The enrolled moyamoya disease patients were divided into the “poor prognosis group” (Matsushima grade 0 or 1) and the “good prognosis group” (Matsushima grade 2 or 3) according to their Matsushima grade. The ΔCBF and ΔnCBF values of patients in the “poor prognosis group” were lower than those in the “good prognosis group”, and the differences were statistically significant (ΔCBF: t = −2.213, P = 0.039; ΔnCBF: t = −3.079, P = 0.006). Conclusion: 1) MRI-ASL can be used for quantitative determination of local cerebral blood flow and assessment of regional cerebral hemo-dynamics in moyamoya disease patients. 2) The preoperative mean cerebral blood flow measured by the “meta-quintile measurement” is positively correlated with the preoperative neurological function of patients with moyamoya disease, which has reference value for the evaluation of the se-verity of the disease; 3) The average cerebral blood flow before and after combined cerebral blood flow reconstruction was measured and compared by the “meta-quintile measurement”, which can be used to evaluate the effect of blood flow improvement and has reference value for prognosis as-sessment.