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目的 评价脑灌注MR和血管造影在判断缺血性脑血管病病变性质中的价值。方法 本组包括 16例具有缺血性脑血管病症状的病人 ,均进行了脑灌注MR扫描和脑血管造影造影检查。脑灌注MR包括局部脑血容量图 (rCBV)和平均通过时间图 (MTT)。结果 脑灌注MR扫描发现 2 7个缺血病灶 ,其中 6个为脑梗死 ,2 1个为缺血性病灶。绝大部分病灶 (2 6 / 2 7)表现为MTT延长 ,MTT图对是否存在缺血灶十分敏感 ,但很难区分脑缺血和脑梗死。梗死灶全部表现为rCBV降低 ,而大部分缺血病灶表现为正常或稍高的rCBV。当脑血管造影证实存在侧枝循环时 ,大部分病灶表现为缺血改变而没有脑梗死 ,脑灌注MR表现为正常或稍高的rCBV。脑血管造影未能证实侧枝循环时 ,5 1 7%的病灶为缺血灶 ,5 0 %表现为rCBV下降 ,另 5 0 %为正常或增高的rCBV。结论 血管造影证实存在侧枝循环是缺血性脑血管病预后性质较好的征象 ,但在血管造影无侧支循环时 ,正常或增高的rCBV可能提示存在着足够的侧支循环。脑灌注成像在评价缺血性脑血管病性质中是一种有效的辅助工具 ,特别是在脑血管造影未能证实侧枝循环的病人中
Objective To evaluate the value of cerebral perfusion MR and angiography in judging the pathological changes of ischemic cerebrovascular disease. Methods The group consisted of 16 patients with ischemic cerebrovascular disease who underwent MR perfusion and angiography. Cerebral perfusion MR includes regional cerebral blood volume map (rCBV) and mean transit time (MTT). Results There were 27 ischemic lesions detected by MR perfusion in brain perfusion. Six of them were cerebral infarction and 21 were ischemic lesions. The vast majority of lesions (26/27) showed prolonged MTT. The MTT pattern was very sensitive to the presence or absence of ischemic lesions, but it was difficult to distinguish between cerebral ischemia and cerebral infarction. All of the infarcts showed decreased rCBV, while most ischemic lesions showed normal or slightly higher rCBV. When cerebral angiography confirmed the presence of collateral circulation, most of the lesions showed ischemic changes without cerebral infarction, and cerebral perfusion MR showed normal or slightly higher rCBV. Cerebral angiography failed to confirm collateral circulation, 51.7% of the lesions were ischemic foci, 50% showed decreased rCBV, and the other 50% were normal or elevated rCBV. Conclusions Angiography confirmed the presence of collateral circulation as a predictor of the prognostic nature of ischemic cerebrovascular disease. However, normal or elevated rCBV may suggest adequate collateral circulation during collateral circulation without angiography. Cerebral perfusion imaging is an effective adjunct to evaluating the properties of ischemic cerebrovascular disease, especially in patients who have failed to confirm collateral circulation in cerebrovascular angiography