作者：唐鑫，敬方园，谢欢，钱晓东，李超，林果

单位：

1.638000四川省广安市人民医院放射科 2.629200四川省遂宁市第一人民医院放射科 通信作者：敬方园，E-mail：3318787904@qq.com

Units：

1.Department of Radiology, Guang'an People's Hospital, Guang'an 638000, China2.Department of Radiology, Suining First People's Hospital, Suining 629200, ChinaCorresponding author: JING Fangyuan, E-mail: 3318787904@qq.com

关键词：

中枢神经系统血管炎; 高分辨率MRI; 动态对比增强MRI; 诊断; 预后;

Keywords：

Central nervous system vasculitis; High-resolution magnetic resonance imaging; Dynamic contrastenhanced magnetic resonance imaging; Diagnosis; Prognosis

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.059

Funds：

2018年度重庆市第十三批科技计划项目（cstc2018jscx-msyb0383）

摘要：

背景高分辨率(HR)-MRI可以对血管腔壁清晰成像,动态对比增强(DCE)-MRI可以评估血-脑脊液屏障(BBB)的完整性。目的 分析HR-MRI和DCE-MRI在中枢神经系统血管炎诊断和预后评估中的应用价值。方法 选取2019年7月至2020年9月在广安市人民医院放射科经3D TOF-MRA诊断为单侧大脑中动脉M1段狭窄并疑似中枢神经系统血管炎的患者36例,均行HR-MRI、DCE-MRI检查,记录患者中枢神经系统血管炎检出率及其一般资料、管腔狭窄程度和范围、BBB通透性改变情况。结果 36例患者中23例(占63.9%)确诊为中枢神经系统血管炎,其中脑梗死急性-亚急性期10例、脑梗死慢性期3例、无脑梗死10例。无脑梗死、脑梗死慢性期及脑梗死急性-亚急性期患者管腔狭窄程度和范围比较,差异无统计学意义(P>0.05)。脑梗死急性-亚急性期患者缺血梗死灶区容量转移常数(Ktrans)高于无脑梗死患者(P<0.05)。脑梗死慢性期患者缺血梗死灶区Ktrans高于缺血对侧镜像区(P<0.01);仅2例患者于治疗6个月后进行复查,其缺血梗死灶区Ktrans低于治疗前(P<0.05)。脑梗死急性-亚急性期患者缺血梗死灶区Ktrans高于缺血对侧镜像区(P<0.05);治疗6个月后,缺血梗死灶区Ktrans低于治疗前(P<0.05)。结论 HR-MRI可以评估管腔狭窄程度和范围,且对伴有单侧大脑中动脉M1段狭窄的中枢神经系统血管炎具有一定诊断价值;DCEMRI可以定量检测中枢神经系统血管炎患者BBB的通透性,进而评价患者预后。

Abstract：

【Abstract】 Objective High-resolution (HR) -MRI can clearly image the lumen wall of blood vessels. Dynamiccontrast-enhanced (DCE) -MRI can assess the integrity of the blood-brain barrier. Objective To analyze the application valueof HR-MRI and DCE-MRI in the diagnosis and prognostic evaluation of central nervous system (CNS) vasculitis. MethodsThirty-six patients with suspected CNS vasculitis and unilateral middle cerebral artery M1 stenosis diagnosed by 3D-TOF MRAwho admitted to the Department of Radiology of Guang'an People's Hospital from July 2019 to September 2020 were selected.All patients were examined by HR-MRI and DCE-MRI, the detection rate of CNS vasculitis and its general data, the extent andscope of lumen stenosis, and the permeability of blood-brain-barrier were recorded. Results Among the 36 patients, 23 patients(63.9%) were diagnosed with CNS vasculitis, including 10 cases in acute-subacute phase of cerebral infarction, 3 cases in chronicphase of cerebral infarction and 10 cases without cerebral infarction. There was no significant difference in the degree and scopeof lumen stenosis among patients without cerebral infarction, chronic stage and acute-subacute stage of cerebral infarction (P >0.05) . The volume transfer constant (Ktrans) of ischemic infarct area in patients with acute-subacute phase of cerebral infarctionwas higher than that in patients without cerebral infarction (P <0.05) . In patients with chronic stage of cerebral infarction, Ktrans ofischemic infarct area was higher than that in ischemic contralateral mirror area (P <0.01) ; only 2 patients were reexamined after 6months of treatment, and the Ktrans of ischemic infarct area was lower than that before treatment (P <0.05) . Ktrans of ischemic infarctarea was higher than that in contralateral mirror area in patients with acute-subacute phase of cerebral infarction (P <0.05) ; after6 months of treatment, Ktrans of ischemic infarct area was lower than that before treatment (P <0.05) . ConclusionHR-MRIcan evaluate the degree and extent of lumen stenosis, and has certain diagnostic value for CNS vasculitis with unilateral middlecerebral artery M1 stenosis; DCE-MRI can quantitatively detect the permeability of blood-brain-barrier in patients with CNSvasculitis, and then evaluate the prognosis of patients.

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