| Background and objective: DSA as a gold standard for the diagnosis of carotid artery stenosis has been used widely, mainly to measure the internal carotid artery compared with the normal vascular stenosis, taking into account the symptoms caused by carotid artery stenosis is mainly due to reduced intracranial blood supply, with the same clinical site and same degree of stenosis, but because of collateral circulation compensatory blood supply and other reasons, changes in hemodynamics, resulting in different clinical symptoms, so the carotid artery stenosis in patients with intracranial perfusion blood flow determination, more in line with the patient's physiology and clinical. In this paper, magnetic resonance three-dimensional arterial spin labeling (3D ASL) was used to qualitatively and quantitatively evaluate the cerebral blood perfusion in patients with unilateral carotid artery stenosis. At the same time, 3D ASL was also used to evaluate the changes of early intracranial perfusion after carotid endarterectomy (CEA).Methods: We select 28 patients with unilateral carotid artery stenosis, which were admitted neurosurgical treatment from November 2005 to November 2016 in the People's Liberation Army General Hospital,digital subtraction angiography (DSA)examination was diagnosed as severe stenosis, qualitative observation and quantitative comparison of patients' frontal lobe, temporal lobe, cortical watershed area and subcutaneous watershed area. The CBF values of the control group were analyzed by t-test. Whether there is a difference. Finally, 19 patients underwent carotid endarterectomy and were treated with routine MRI and 3D-ASL perfusion on the first day before surgery, the first day, the second day,the third day ,the fourth day and 3 months after surgery. 3D-ASL review intracranial perfusion, compared with preoperative and postoperative contralateral and ipsilateral frontal lobe, temporal lobe, cortex watershed area and subcutaneous watershed area and other parts of the CBF value, and the use of repeated measurements Data analysis of variance analysis.Results: 1.The ASL images of patients with unilateral carotid artery stenosis were observed. There were differences in perfusion between the narrow side and the health side. The CBF values of frontal lobe, temporal lobe, watershed area and narrow side of the basal ganglia were observed quantitatively. (P <0.01; the temporal lobe: p <0.01; watershed area: p <0.01; basal ganglia p = 0.005 <0.01);2.The preoperative and postoperative perfusion CBF values were compared between the narrow side and the health side of the frontal lobe, the temporal lobe,the watershed area and the basal ganglia, the CBF value of postoperative is higher than that of preoperative, and the difference was statistically significant (p <0.01).Compared with the CBF between the unilateral preoperative and postoperative,the difference of the data of the narrow side frontal lobe was not statistically significant (p >0.05), the difference of the data of the health side frontal lobe was statistically significant (p <0.05), the difference of the data of the temporal lobe,both the narrow side and the health side, were statistically significant (p <0.05).the difference of the data of the narrow side watershed area was statistically significant (p =0.003<0.05), the difference of the data of the health side watershed area was not statistically significant(p=0.067 >0.05). The difference of the data of basal ganglia, both the narrow side and the health side, were statistically significant(p <0.05); 3. Compared with the value of CBF between preoperative and postoperative, the difference of the mean value of the narrow side and the health side of the frontal lobe was statistically significant (p=0.012<0.05). The first day, the second day, the third day, the fourth day and 3 months after the operation, there was no significant difference between the two groups (P> 0.05).The difference of the mean value of the narrow side and the health side of the temporal lobe was statistically significant (p=0.010<0.05). The first day, the second day, the third day and the fourth day after the operation, there was no significant difference between the two groups (P> 0.05), while 3 months after the operation, there was significant difference between the two groups (P< 0.05). The difference of the mean value of the narrow side and the health side of the watershed area was statistically significant (p=0.050 ? 0.05). The first day, the second day, the fourth day and 3 months after the operation, there was no significant difference between the two groups (P> 0.05). While the third day, after the operation, there was significant difference between the two groups (P< 0.05).The difference of the mean value of the narrow side and the health side of the basal ganglia before operation and the first day, the second day, the fourth day and 3 months after the operation, there was no significant difference between the two groups (P> 0.05);4. Compared with the CBF values of patients before and after surgery, the narrow side of the region and normal mirror side among the temporal lobe, temporal lobe, watershed and basal ganglia were changed with time (p<0.05), and the difference of the data of each time were statistically significant.Conclusion: 1 .The distribution of cerebral perfusion in the bispectral hemisphere region of patients with unilateral carotid artery severe stenosis was different. 3D ASL was able to detect the abnormal changes of brain perfusion in patients with severe carotid artery stenosis, and could be used as evaluation of carotid artery stenosis and an important auxiliary examination of surgery is required.2. Frontal lobe, temporal lobe and basal ganglia brain perfusion blood flow was significantly higher than the watershed area, and these areas may be rich in blood vessels,collateral circulation exists at the same time, in the case of intracranial perfusion monitoring, the choice of energy and Oxygen requirements are higher, collateral circulation less watershed area and other parts as the region of interest.3.3D ASL can be used to quantitatively analyze the recovery of perfusion after CEA surgery.After 2-3 days of CEA operation, intracranial hemodynamics recovered significantly, and then gradually returned to normal level, and remained stable at 3 months after operation.4. CEA surgery can effectively restore intracranial perfusion levels, but in the early postoperative we should pay attention to excessive perfusion. |
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