MRI上梗死灶体积及分布状况与交叉性小脑神经机能联系不能的相关性研究

摘要

Objective：To detect the supratentorial infarcts volume and distribution status after unilateral middle cerebral artery occlusion by using diffusion weighted imaging(DWI)，and to discuss their relationship with crossed cerebellar diaschisis(CCD)．Methods：A retrospective analysis was made of imaging data consisting of 16 patients with CCD，including DWI，PWI and MRA．The NEI，TTM and MTE maps were calculated from the original data of perfusion data by GE company special perfusion software．The change degree of rNEI，rTTM and rMTE were calculated in the abnormal hypoperfusion area of contralateral cerebellum and the mirror cerebellum area．Based on abnormal signal in DWI maps，supratentorial in farcts volume and distribution status were calculated．Results：Our results confirmed that all patients showed hypoperfusion in the contralateral cerebellum．Based on DWI maps，13 cases showed abnormal signal in the frontal cortex，10 cases in the basal ganglia，and 9 cases in the internal capsule．There was infarction of supply area of left middle cerebral artery in 11 cases and infarction of supply area of right middle cerebral artery in 5 cases．There were no abnormal signals on DWI maps and on both sides of cerebellum，no obvious anomalous signals of vertebrobasilar artery on MRA maps．There were moderate linear correlations between the reduction rate of cerebellar rNEI and supratentorial infarcts volume(P<0．05)．Conclusion：Our data indicate that CCD may Occur in patients after unilateral middle cerebral artery occlusion，and is related with supratentorial infarcts volume and the distribution status．%目的:通过MRI测量幕上梗死灶体积及明确梗死灶分布状况,探讨其与交叉性小脑神经机能联系不能(CCD)间的关系.方法:对16例CCD患者的3.0T MRI资料进行回顾性分析,包括DWI、灌注成像(PWI)以及MRA资料.PWI原始数据经后处理得到负性增强积分(NEI)、到达峰值时间(TTM)及平均增强时间(MTE)的灌注伪彩图,并于幕上梗死灶对侧小脑异常灌注区及同侧小脑镜像区选择兴趣区,计算局部负性增强积分(rNEI)、局部到达峰值时间(rTTM)和局部平均增强时间(rMTE)的改变程度.于DWI图上测量梗死灶体积及明确梗死灶分布状况,分析其与CCD发生可能存在的关系.结果:16例患者中,梗死累及额叶皮质13例,累及基底节10例,累及内囊9例,DWI均表现为单侧局灶性幕上高信号影,其中11例梗死灶累及左侧大脑中动脉供血区,5例累及右侧大脑中动脉供血区.DWI上两侧小脑无明显异常信号.幕上梗死灶对侧小脑均出现灌注异常,表现为rNEI值较镜像侧降低,rTTM值及rMTT值明显延长.MRA示16例均未见两侧大脑后动脉及椎基底动脉异常,7例患者为左侧大脑中动脉M1段狭窄、闭塞,4例为左侧大脑中动脉M2段闭塞,5例为右侧大脑中动脉M1段局限性狭窄、闭塞.梗死灶体积与对侧小脑rNEI值改变程度存在相关性(r=0.664,P<0.05),与rTTM值及rMTE值改变程度之间无显著相关性(r值分别为0.120、0.204,P>0.05).结论:CCD的发生不仅与梗死灶体积大小有关,而且与脑组织损伤的分布状况存在一定联系.