脑后循环缺血患者功能性后交通动脉的相位对比MR血管成像研究

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目的:应用相位对比磁共振血管成像(PC MRA)定量研究脑后循环缺血(PCI)患者的功能性后交通动脉(F-PCoA)的血流动力学特征及临床意义。方法:回顾性搜集2015年4月至2017年3月南方医科大学顺德医院的PC MRA资料,临床诊断PCI且存在F-PCoA者26例(PCI组),临床排除PCI者25例(非PCI组),其中包括10例存在F-PCoA(非PCI组1)和15例不存在F-PCoA(非PCI组2)。记录基底动脉(BA)的截面积和平均流量、平均流速、最小流量、最大流量、最小流速、最大流速,并计算流量峰高(最大流量-最小流量)、流速峰高(最大流速-最小流速),记录F-PCoA的亚型、截面积、平均流量、平均流速,根据流速的正负号判断血流方向,计算F-PCoA前向后绝对流量(左侧F-PCoA前向后绝对流量+右侧F-PCoA前向后绝对流量),并进行统计分析。结果:将PCI组和非PCI组1中存在F-PCoA的36例分为3型:(1) A型:F-PCoA与解剖性后交通动脉(A-PCoA)一致30例;(2) B型:F-PCoA与A-PCoA不一致5例;(3) C型:混合型,一侧F-PCoA与A-PCoA一致但另一侧不一致1例。PCI组与非PCI组1的F-PCoA亚型构成比差异无统计学意义(χn 2=0.609,n P=0.737)、前向后绝对分流量差异无统计学意义(n t=-0.576,n P=0.568),一个心动周期内同一支F-PCoA的血流可为单向或双向,同一病例双侧F-PCoA的血流方向可相同也可不同,但PCI组的F-PCoA前向后绝对分流量曲线有更明显的主波峰。非PCI组中,非PCI组1和非PCI组2的比较,仅BA横截面积差异有统计学意义(n t=-2.856,n P=0.009),而性别构成、年龄分布、BA平均流量、平均流速、最小流量、最大流量、流量峰高、最小流速、最大流速及流速峰高差异均无统计学意义。n 结论:应用PC MRA可定量分析F-PCoA的血流方向、流速及流量等血流动力学信息,F-PCoA的前向后绝对分流量结合血流曲线的形态改变,可能为PCI诊疗提供新的辅助参考信息。“,”Objective:To investigate the application value of phase contrast MR angiography (PC MRA) in quantitative assessment for the hemodynamic features of functional posterior communicating artery (F-PCoA) in the patients with posterior circulation ischemia (PCI).Methods:Data of PC MRA in our Hospital from April 2015 to March 2017 were collected retrospectively. Twenty-six patients (PCI group) were diagnosed as PCI with F-PCoA, and other 25 patients were defined as non-PCI group including 10 patients with F-PCoA (non-PCI group 1) and 15 patients without F-PCoA (non-PCI group 2). The cross-sectional area, mean flux, mean velocity, minimum flux, maximum flux, minimum velocity, and maximum velocity were recorded, and the peak height of flux (maximum flux-minimum flux) and peak height of velocity (maximum velocity - minimum velocity) of basilar artery (BA) were calculated. The subtype, cross-sectional area, mean flux, mean velocity, blood flow direction, and absolute flux of F-PCoA in anterior-posterior direction(sum of both sides)were recorded and analyzed statistically.Results:The F-PCoA of 36 cases in PCI group and non-PCI group 1 were divided into three types: type A: the F-PCoA was consistent with anatomical posterior communicating artery (A-PCoA), accounting for 83.3%(30/36 cases); type B: the F-PCoA was not consistent with A-PCoA, accounting for 13.9%(5/36 cases);and type C: a mixed type with the F-PCoA was consistent with A-PCoA in only one side, accounting for 2.8%(1/36 cases). There were no significant differences in the composition of F-PCoA subtype (χn 2=0.609, n P=0.737) and the absolute flux of F-PCoA in anterior-posterior direction(n t=-0.576, n P=0.568) between PCI group and non PCI group 1. It could be unidirectional or bidirectional blood flow forasingle F-PCoA during a cardiac cycle. The blood flow direction of bilateral F-PCoA was similar or not in one single case. The obviously main wave peak of the absolute flux curve of F-PCoA in anterior-posterior direction in PCI group were observed. There was a significant difference in the cross-sectional area of BA between non PCI group 1 and 2(n t=-2.856, n P=0.009), however no significant differences were found in the genders, mean flux, mean velocity, minimum flux, maximum flux, peak height of flux, minimum velocity, maximum velocity, and peak height of velocity of BA.n Conclusions:PC MRA can be used to quantificationally assess the hemodynamic characteristics of F-PCoA such as flow direction, velocity and flux direction, absolute flux in anterior-posterior direction and morphological changes of F-PCoA, which may provide more information for the PCI diagnosis and treatment.
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