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目的探讨动态磁敏感对比磁共振成像(DSC-MRI)在多发性硬化(MS)各种病灶和看似正常表现脑白质(NAWM)区的灌注特征。资料与方法 45例复发-缓解型MS(RRMS)患者行常规MRI和DSC-MRI灌注成像,分析强化病灶、非强化病灶及病灶对侧NAWM区的MR灌注信号强度-时间曲线和脑血容量伪彩图,同时测量并计算最大相对局部脑血容量(rrCBV)、最大相对局部脑血流量(rrCBF)和最大相对局部平均通过时间(rrMTT),并与15例与之年龄匹配的对照组比较。结果 (1)DSC-MRI灌注显示MS强化病灶、NAWM区与对照组比较,灌注信号强度-时间曲线和伪彩图之间差异有统计学意义(P<0.01),灌注明显减少,MTT延长。(2)MS强化病灶与对侧NAWM区比较,最大rrCBV值显著升高,差异有统计学意义(P<0.01)。(3)非强化病灶中,类似空洞低信号病灶与等信号及稍低信号病灶比较,最大rrCBV值显著降低,差异有统计学意义(P<0.01);T1WI呈稍低信号病灶与对侧NAWM区比较,最大rrCBV差异无统计学意义,T1WI呈等信号病灶与对侧NAWM区比较,最大rrCBV有重叠。结论 DSC-MRI灌注成像提示MS斑块和NAWM区存在血流动力学异常和微血管损害,反映了不同的病理改变。
Objective To investigate perfusion characteristics of dynamic magnetic resonance contrast-enhanced magnetic resonance imaging (DSC-MRI) in various lesions of multiple sclerosis (MS) and normal appearing white matter (NAWM) areas. Materials and Methods Forty-five patients with relapsed-remitting MS (RRMS) underwent routine MRI and DSC-MRI perfusion imaging to analyze MR perfusion intensity-time curve and cerebral blood volume pseudo-contrast in intensive lesion, non-enhanced lesion and contralateral NAWM area Color images were obtained. The maximum relative regional cerebral blood volume (rrCBV), maximum relative regional cerebral blood flow (rrCBF) and maximum relative local transit time (rrMTT) were measured and compared with 15 matched age-matched controls. Results (1) DSC-MRI perfusion showed MS-enhanced lesions. Compared with the control group, there was a significant difference between perfusion signal intensity-time curve and false color map (P <0.01). Perfusion was significantly reduced and MTT prolonged. (2) Compared with the contralateral NAWM area, the maximum rrCBV value of MS-enhanced lesions was significantly increased, the difference was statistically significant (P <0.01). (3) The maximum rrCBV was significantly lower in non-enhanced lesion with similar empty low signal lesion as compared with the lesion with equal signal and slightly lower signal (P <0.01); T1WI showed slightly lower signal lesion and contralateral NAWM There was no significant difference in maximal rrCBV between the two groups. T1WI showed equal signal lesions and contralateral NAWM area, and the maximum rrCBV overlap. Conclusion DSC-MRI perfusion imaging suggests that hemodynamic abnormalities and microvascular damage exist in MS plaques and NAWM areas, reflecting different pathological changes.