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目的评估使用精确的前瞻性靶向CO2激励和血氧水平依赖MR成像对临床人群脑血管反应性(CVR)绘图的安全性、耐受性、技术可行性。材料与方法机构伦理委员会批准了三级医院在2006年1月1日—2010年12月1日对所有CVR的研究进行病历审查,均获得病人的知情同意。检索不利事件的发生和失败的检查。2名观察者采用双盲法对CVR图的诊断质量进行评估,分为好、可诊断但质量差、无法诊断。结果作为原始数据并进行描述性统计(均值±标准差)。使用同类相关系数来测定观察者内部的变异度。结果对294例病人(女性占51.8%)的432次连贯的CVR检查进行研究。病人年龄范围9~88岁[平均(45.9±20.6)岁]。有48次检查(11.1%)在高碳酸血症阶段出现气促、头痛、头晕等短暂症状,均未出现神经病学中的脑缺血事件、心肌梗死和其他主要并发症。CVR影像生成的成功率为83.9%(364/434次)。另外70次检查失败(16.1%),其中有25次感到不适(35.7%),8次(11.4%)出现头部移动,2次(2.9%)为不能合作,10次(10.0%)为设备出现技术性障碍,28次为情况不明或未说明状态。在364次成功的检查中,质量好的CVR图为340次(93.4%),可诊断但质量差的有12次(3.3%),无法诊断的有12次(3.3%)。结论在临床病人的研究中,使用精确的前瞻性靶向CO2激励和血氧水平依赖MR成像所产生的CVR图是安全的、可耐受的,并且技术上也是可行的。
Objectives To evaluate the safety, tolerability and technical feasibility of using prospectively targeted CO2-inspired and oxygen-level-dependent MR imaging for mapping of cerebrovascular reactivity (CVR) in the clinical population. Materials and Methods The Institutional Ethics Committee approved the level III hospital review of all CVR studies conducted from January 1, 2006 to December 1, 2010, all with the patient’s informed consent. Retrieve the occurrence of adverse events and failure of the inspection. Two observers used the double-blind method to evaluate the diagnostic quality of the CVR chart, which was divided into good, diagnosable but poor quality and could not be diagnosed. Results were used as raw data and descriptive statistics (mean ± standard deviation). Similar coefficients of correlation were used to determine the variability within the observer. Results 432 consecutive CVR examinations of 294 patients (51.8% of women) were studied. Patients ranged in age from 9 to 88 years [mean (45.9 ± 20.6) years]. There were 48 examinations (11.1%) with brief symptoms such as shortness of breath, headache, and dizziness at the hypercapnia stage without neurological ischemic events, myocardial infarction, and other major complications. The success rate of CVR imaging was 83.9% (364/434). Another 70 failed examinations (16.1%), 25 felt uncomfortable (35.7%), 8 (11.4%) had head movements, 2 (2.9%) failed and 10 (10.0% Technical difficulties, 28 times unknown or unexplained state. Of the 364 successful examinations, good CVRs were 340 (93.4%), 12 (3.3%) were diagnosed but of poor quality, and 12 (3.3%) were not diagnosed. Conclusions In clinical patient studies, the use of precise, prospectively targeted C02 stimulation and oximetry-dependent CVR images generated by MR imaging is safe, tolerable and technically feasible.