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目的用MR灌注成像技术评价亚临床肝性脑病(SHE)患者的脑血流灌注模式。方法对12例经神经心理试验诊断为SHE的患者和10例年龄和教育程度相匹配的健康志愿者进行MR平扫和灌注成像,分别测量双侧尾状核头、苍白球、壳核、丘脑和额叶白质的脑血容量(CBV)、脑血流量(CBF)和平均通过时间(MTT),并以同侧额叶脑白质作为参照进行统计分析。结果SHE患者各感兴趣区与白质的比值:CBV值分别是1.32±0.25、1.19±0.46、1.51±0.20、1.69±0.53;CBF值分别为1.64±0.50、1.61±0.65、2.06±0.61、2.23±0.75;MTT值分别是0.83±0.17、0.76±0.20、0.78±0.19、0.78±0.17。志愿者相应部位CBV值为1.32±0.33、1.02±0.29、1.44±0.37、1.66±0.57;CBF值为1.36±0.24、1.08±0.28、1.55±0.51、1.58±0.64;MTT值为0.95±0.18、0.91±0.19、0.93±0.15、0.93±0.13。SHE患者较正常组MTT明显缩短,双侧丘脑、右侧尾状核头达到统计学意义的降低(P<0.05);CBF明显升高,左侧苍白球达到统计学意义的升高(P<0.05);CBV无明显变化。结论SHE患者基底节区灌注增加是血流从皮质到基底节区的重新分布,这是对运动前区、运动区功能缺陷及注意力缺陷的代偿反应,与皮质-基底节-丘脑-皮质环路密切相关。
Objective To evaluate the cerebral perfusion pattern in patients with subclinical hepatic encephalopathy (SHE) by MR perfusion imaging. Methods Twelve patients with SHE diagnosed by neuropsychological test and 10 healthy volunteers with the same age and educational level underwent MR plain imaging and perfusion imaging. The bilateral caudate nucleus, globus pallidus, putamen, thalamus (CBV), cerebral blood flow (CBF) and mean transit time (MTT) of frontal lobe white matter, and the ipsilateral frontal lobe white matter as a reference for statistical analysis. Results The ratio of CBV to white matter in SHE patients was 1.32 ± 0.25, 1.19 ± 0.46, 1.51 ± 0.20 and 1.69 ± 0.53, respectively; the CBF values were 1.64 ± 0.50, 1.61 ± 0.65, 2.06 ± 0.61 and 2.23 ± 0.31 respectively 0.75; MTT values were 0.83 ± 0.17, 0.76 ± 0.20, 0.78 ± 0.19 and 0.78 ± 0.17, respectively. The CBV values of the corresponding volunteers were 1.32 ± 0.33, 1.02 ± 0.29, 1.44 ± 0.37 and 1.66 ± 0.57 respectively; the CBF values were 1.36 ± 0.24, 1.08 ± 0.28, 1.55 ± 0.51 and 1.58 ± 0.64; the MTT values were 0.95 ± 0.18 and 0.91 ± 0.19, 0.93 ± 0.15, 0.93 ± 0.13. Compared with the normal group, the MTT of SHE patients was significantly shortened, the bilateral thalamus and right caudate nucleus decreased statistically (P <0.05), CBF increased significantly, and the left globus pallidus reached statistical significance (P < 0.05); no significant changes in CBV. Conclusions Increased basal ganglia perfusion in SHE is a redistribution of blood flow from the cortex to the basal ganglia, which is a compensatory response to functional impairment and attentional deficits in the pre-motor area, motor area, and cortical-basal ganglia-thalamic-cortex The loop is closely related.