medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-883medvis-883Research ArticleГОЛОВАHEADМетодика оценки цереброваскулярной недостаточности у пациентов с ангиопатией мойя-мойя методом МР-ASL-перфузииAssessment of cerebrovascular insufficiency with MR-ASL perfusion in patients with moyamoya angiopathyhttps://orcid.org/0000-0002-2887-1583ШульгинаА. А.ShulginaA. A.

Шульгина Анна Алексеевна, аспирант, врач-нейрохирург 4-го нейрохирургического отделения

125047 Москва, 4-я Тверская-Ямская ул., дом 16

Anna A. Shulgina, postgraduate student, neurosurgeon of the 4th Neurosurgical department

16, 4 Tverskaya-Yamskaya str., Moscow, 125047

ashulgina@nsi.ruhttps://orcid.org/0000-0001-5787-484XЛукшинВ. А.LukshinV. A.

Лукшин Василий Андреевич, доктор мед. наук, старший научный сотрудник 4-го нейрохирургического -отделения, врач-нейрохирург

125047 Москва, 4-я Тверская-Ямская ул., дом 16

Vasily A. Lukshin, Doct. of Sci. (Med.), Senior Researcher of the 4th Neurosurgical department, neurosurgeon

16, 4 Tverskaya-Yamskaya str., Moscow, 125047

wlukshin@nsi.ruhttps://orcid.org/0000-0001-5406-944XШульцЕ. И.ShultsE. I.

Шульц Евгений Игоревич, врач-рентгенолог отделения рентгеновских и радиоизотопных методов диагностики

125047 Москва, 4-я Тверская-Ямская ул., дом 16

Eugeny I. Shults, radiologist of Neuroradiology department

16, 4 Tverskaya-Yamskaya str., Moscow, 125047

EShults@nsi.ruhttps://orcid.org/0000-0002-8924-7346БаталовА. И.BatalovA. I.

Баталов Артем Игоревич, младший научный сотрудник отделения рентгеновских и радиоизотопных методов диагностики, врач-рентгенолог

125047 Москва, 4-я Тверская-Ямская ул., дом 16

Artem I. Batalov, Junior Researcher, radiologist of Neuroradiology department, Deputy Director

16, 4 Tverskaya-Yamskaya str., Moscow, 125047

abatalov@nsi.ruhttps://orcid.org/0000-0003-3749-8706ПронинИ. Н.ProninI. N.

Пронин Игорь Николаевич, академик РАН, доктор мед. наук, профессор, заведующий отделением рентгеновских и радиоизотопных методов диагностики, врач-рентгенолог

125047 Москва, 4-я Тверская-Ямская ул., дом 16

Igor N. Pronin, Full Мember of the Russian Academy of Sciences, Doct. of Sci. (Med.), Professor, Head of Neuroradiology department, Deputy Director

16, 4 Tverskaya-Yamskaya str., Moscow, 125047

Pronin@nsi.ruhttps://orcid.org/0000-0002-9811-9442УсачевД. Ю.UsachevD. Yu.

Усачев Дмитрий Юрьевич, член-корр. РАН, доктор мед. наук, профессор, и .о. директора, врач-нейрохирург 4-го нейрохирургического отделения

125047 Москва, 4-я Тверская-Ямская ул., дом 16

Dmitry Yu. Usachev, Corresponding Member of the Russian Academy of Sciences, Doct. of Sci. (Med.), Professor, Acting Director

16, 4 Tverskaya-Yamskaya str., Moscow, 125047

dousachev@nsi.ruФГАУ “НМИЦ нейрохирургии имени академика Н. Н. Бурденко” Минздрава РоссииРоссияFederal State Autonomous Institution “N. N. Burdenko National Medical Research Center of Neurosurgery”of the Ministry of Health of the Russian FederationRussian Federation202105052021252102115Copyright © Шульгина А.А., Лукшин В.А., Шульц Е.И., Баталов А.И., Пронин И.Н., Усачев Д.Ю., 20212021Шульгина А.А., Лукшин В.А., Шульц Е.И., Баталов А.И., Пронин И.Н., Усачев Д.Ю.Shulgina A.A., Lukshin V.A., Shults E.I., Batalov A.I., Pronin I.N., Usachev D.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/883Цель исследования

Цель исследования: разработка методики оценки степени цереброваскулярной недостаточности у пациентов с ангиопатией мойя-мойя (АММ) на основе измерения значений мозгового кровотока (CBF) и определения наличия артериального транзитного артефакта (ATA) по данным МРТ методом меченых артериальных спинов (ASL).

Материал и методы

Материал и методы. В исследование вошло 47 пациентов с АММ, которым было проведено 148 МР-исследований в режиме PCASL (296 полушарий), из них 47 (94 полушария) – до оперативного лечения. На полученных перфузионных картах вручную выставлены 7 областей интереса (ROI) в сером и белом веществе головного мозга с помощью методики Fusion вне зон АТА. Оценивались значения CBF в центральной точке АТА. 47 пациентам на дооперационном этапе была выполнена прямая ангиография для оценки стадии заболевания по Suzuki, наличия и выраженности лептоменингеальных и трансдуральных коллатералей и МР-ангиография для оценки стадии заболевания по Houkin и уровня стеноза ВСА. Статистическая обработка включала однофакторный дисперсионный анализ (ANOVA) и критерий χ2 (IBM SPSS Statistics 23).

Результаты

Результаты. АТА были выявлены в 77% исследований (69% полушарий). Среднее минимальное значение CBF в АТА составило 120,2 ± 21,1 мл/мин / 100 г при нижней границе доверительного интервала 117,43 мл/мин/100 г. Среднее максимальное значение CBF в АТА составило 234,9. В зависимости от зна чений CBF в бассейне СМА и наличия АТА были выделены 4 степени перфузионного дефицита: степень 0 (CBF = 64,5 ± 16,2 мл/мин/100 г, без АТА) соответствовала стадии “компенсации” мозгового кровотока, степень 1 (CBF = 61,5 ± 16,6 мл/мин/ 100 г, с АТА) – “субкомпенсации”, степень 2 (CBF = 26,5 ± 7,2 мл/мин/100 г, с АТА) – “начальной декомпенсации”, степень 3 (CBF = 16,0 ± 4,7 мл/мин/ 100 г, без АТА) – “декомпенсации”. Выделенные степени статистически значимо различались между собой во всех ROI (p < 0,0001). Более выраженный перфузионный дефицит соответствовал более развернутым стадиям АММ по Suzuki и Houkin, стенозу ВСА проксимальнее отхождения ЗСА (p < 0,0001), большему неврологическому дефициту (p < 0,02). Возникновение АТА достоверно отражало наличие лептоменингеальных коллатералей (p < 0,001).

Выводы

Выводы. Предложенная методика оценки паттернов ASL-перфузионных исследований хорошо согласуется со стадией заболевания, наличием источников коллатерального кровообращения, тяжестью неврологического дефицита и может использоваться для оценки цереброваскулярной недостаточности у пациентов с АММ.

Purpose

Purpose. To develop a methodology for assessing the degree of cerebrovascular insufficiency in patients with moyamoya angiopathy (AMM) based on measurement of cerebral blood flow (CBF) and determination the presence of arterial transit artifact (ATA) using MR method of arterial spin labeling (ASL).

Materials and methods

Materials and methods. The study included 47 patients with AMM who underwent 148 MR studies in PCASL mode (296 hemispheres), of which 47 (94 hemispheres) were done before surgical treatment. On received perfusion maps 7 areas of interest (ROI) were manually set in the gray and white matter of the brain using “Fusion” technique outside the ATA zones. The CBF values at the central point of the ATA were estimated. In the preoperative stage, 47 patients underwent direct angiography to assess the stage of the disease according to Suzuki, the presence and severity of leptomeningeal and transdural collaterals and MR angiography to assess the stage of the disease according to Houkin and the level of ICA stenosis. Statistical processing included univariate analysis of variance (ANOVA) and chi-square test (IBM SPSS Statistics 23).

Results

Results. ATA was detected in 77% of studies (69% of hemispheres). The average minimum CBF in ATA was 120.2 ± 21.1 ml/min/ 100 g at the lower bound of the confidence interval of 117.43 ml/min / 100 g. The average maximum CBF in ATA was 234.9. Depending on the CBF values in the MCA territory and the presence of ATA, 4 degrees of perfusion deficiency were identified: degree 0 (CBF = 64.5 ± 16.2 ml/min / 100 g, without ATA) corresponded to the stage of “compensation” of cerebral blood flow, degree 1 (CBF = 61.5 ± 16.6 ml/min/ 100 g, with ATA) – “subcompensation”, degree 2 (CBF = 26.5 ± 7.2 ml/min/100 g, with ATA) – “initial decompensation”, degree 3 (CBF = 16.0 ± 4.7 ml/min / 100 g, without ATA) – “decompensation”. The highlighted degrees statistically significantly differed among themselves in all ROIs (p < 0.0001). More severe perfusion deficiency corresponded to the more developed stages of AMM according to Suzuki and Houkin, proximal stenosis of the ICA (p < 0.0001), and more severe neurological deficit (p < 0.02). The occurrence of ATA reliably reflected the presence of leptomeningeal collaterals (p < 0.001).

Conclusions

Conclusions. The proposed method for assessing patterns of ASL perfusion has a good agreement with the stage of the disease, the presence of sources of collateral circulation, the severity of neurological deficit and can be used to assess cerebrovascular insufficiency in patients with AMM.

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The authors declare that there are no conflicts of interest present.