动脉自旋标记在评估甲状腺功能亢进患者脑血流灌注情况中的应用研究

摘要

目的 探索动脉自旋标记(arterial spin labeling,ASL)在研究甲状腺功能亢进患者脑灌注情况的可行性并分析其与健康人群在脑灌注上的差异.方法 收集年龄、性别、文化程度相匹配的17名甲亢患者(实验组)和16名健康志愿者(对照组)行常规颅脑磁共振检查及三维假连续式动脉自旋标记(three dimensional pseudocontinuous ASL,3D-pCASL)序列检查,测量实验组与对照组各脑区的脑血流量值(cerebral blood flow,CBF).结果 甲亢患者双侧额叶、颞叶、枕叶、基底节区及海马区的CBF较健康对照者减低( P均<0.05,其中,双侧额叶、枕叶、左侧基底节区、右侧颞叶、右侧海马区P <0.01).右侧额叶CBF与促甲状腺激素(thyroid stimulating hormone,TSH)浓度呈正相关( r =0.7820,P <0.05);诸脑区CBF与游离三碘甲状腺原氨酸(free triiodothyronine,FT3)及游离甲状腺素(free thyroxine, FT4)浓度无明显相关性;诸脑区CBF与促甲状腺素受体(thyrotropin receptor antibody,TRAb)浓度无明显相关性;右侧基底节区、右侧顶叶、左侧顶叶CBF与病程长短呈正相关( r =0.7576、r =0.7576、r =0.8257,P均<0.05).结论 利用ASL评估甲亢患者脑灌注情况具有可行性.其双侧额叶、颞叶、枕叶、基底节区及海马区存在明显低灌注;右侧额叶灌注对血清TSH水平敏感;右侧基底节区、右侧顶叶、左侧顶叶灌注情况对病程时间长短敏感.%Objective To explore whether arterial spin labeling(ASL) technique was an appropriate tool to assess conditions of cerebral perfusion in hyperthyroidism patients (HTP) Besides, we would analyze the difference of cerebral perfusion between HTP and healthy volunteers. Methods Seventeen HTP and sixteen healthy volunteers as control matched for age,sex,education were performed conventional MR imaging and three dimensional pseudocontinuous ASL (3D-pCASL), the cerebral blood flow (CBF) values of each brain region in HTP and controls were measured. Results Compared with control group,HTP had signifi-cantly decreased CBF values in bilateral frontal lobe,temporal lobe,occipital lobe,basal ganglia and hippocampus areas. (all P<0.05,the p value ofbilateral frontal lobe,bilateral occipital lobe,left basal ganglia,right temporal lobe,left hippocampus are-as was <0.01). CBF of right frontal lobe was positively correlated with concentration of thyroid stimulating hormone (TSH)( r=0.7820,P <0.05);CBF of every brain region in HTP was not significantly correlated with concentration of free triiodothyro-nine (FT3) and free thyroxine(FT4);CBF of each brain region in HTP was not significantly correlated with concentration of thy-rotropin receptor antibody(TRAb),too;CBF of right basal ganglia,right parietal lobe,left parietal lobe was positively correlated with disease duration ( r =0.7576,r =0.7576,r =0.8257,all P <0.05). Conclusion ASL is appropriate for assessment of conditions of cerebral perfusion in HTP,among whom an obvious reduction of blood perfusion is demonstrated in bilateral frontal lobes,temporal lobes,occipital lobes,basal ganglia and hippocampus areas. The conditions of perfusion in right lobes of HTP are sensitive to the level of TSH and that in right basal ganglia and bilateral parietal lobes depend on the course of disease.