Clinical Application Of DSC-PWI And DCE-MRI In Theory Of Normal Perfusion Pressure Breakthrough

Objective:Normal perfusion pressure breakthrough is one of the serious complications after surgical treatment of cerebral arteriovenous malformation.In our study,dynamic susceptibility contrast-enhanced perfusion weighted imaging and dynamic contrast-enhanced magnetic resonance imaging were used to evaluate the blood flow perfusion and microvascular permeability of brain tissue around cerebral arteriovenous malformations,to explore the pathogenesis of normal perfusion pressure breakthrough after resection of cerebral arteriovenous malformations and the clinical application value of MRI technology in the theory of normal perfusion pressure breakthrough.Clinical data and methods:A total of 21 patients with cerebral arteriovenous malformation who were admitted to the department of neurosurgery of China-Japan Union Hospital of Jilin University from March 2014 to August 2019 were collected as subjects.All the patients were diagnosed as cerebral arteriovenous malformation by DSA examination and treated by surgery.Then,the corresponding quantitative parameters of DCE-MRI andDSC-PWI were obtained through the post-processing of the original image by professional software.Through statistical analysis of various parameters and qualitative analysis of the differences in nuclear magnetic images,the changes in cerebral tissue perfusion and microvascular permeability near the lesions before and after the operation of cerebral arteriovenous malformation were statistically analyzed.Results:1.In the AVM group with the maximum diameter of lesion ≤6cm,there was no significant difference in microvascular perfusion and permeability of brain tissue around the lesion and the mirror image region before surgical treatment through comparative analysis of DCE-MRI and DSC-PWI parameters(P values were > 0.05),and no significant change in qualitative observation image data.2.In the AVM group with the maximum diameter of lesion ≤6cm,the changes of parameters before and after DCE-MRI and DSC-PWI surgery were compared and analyzed.There was no significant difference in the changes of microvascular perfusion and permeability of brain tissue around AVM before and after lesion resection(P values were > 0.05).There was no significant change in the qualitative observation data.3.The extension of MTT and TTP in peripheral brain tissues was observed by qualitative analysis of the giant AVM cases with lesions larger than 6cm,and further prolonged of MTT and TTP in peripheral brain tissues after lesion resection;Postoperative and preoperative DCE-MRI pseudocolor images showed no increase in vascular permeability in either group.Conclusion:1.Normal perfusion pressure breakthrough is a rare and life-threatening complication after cerebral arteriovenous surgical resection or endovascular embolization,and its pathogenesis is not yet clear and its occurrence is difficult to predict;2.For AVM with malformation focus less than 6cm,there was no hypoperfusion in the brain tissue around AVM caused by steal blood of malformation group before lesion removal by DSC-PWI,and there was no microvascular permeability change in the brain tissue around AVM before operation by DCE-MRI;3.The AVM of the brain less than 6cm was detected by DSC-PWI and DCE-MRI,but there was no sign of increased perfusion and vascular permeability around the lesion.4.There may be hypoperfusion and postoperative hyperperfusion in the area around the lesion in the giant AVM patients with lesions larger than6 cm.This conclusion needs further observation in large cases.