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Objective To explore the value of intravoxel incoherent motion (IVIM) imaging in evaluating diffusion and perfusion variations in subacute brain infarction.Methods MRI data of 35 patients with subacute brain infarction were analyzed retrospectively,including routine DWI,IVIM imaging and three-dimensional arterial spin labeling (3D-ASL) sequence.The ADC maps were obtained by routine DWI sequence.Pure molecular-based diffusion coefficient (D) maps,pseudo diffusion coefficient of perfusion (D*) maps and perfusion fraction (f) maps were obtained by IVIM sequence.Cerebral blood flow (CBF) maps were obtained by 3D-ASL sequence.ADC,D,D*,f,CBF values and the relative values (rADC,rD,rD*,rf,rCBF) of brain infarction lesion and contralateral mirror area were calculated.All the parameters between brain infarction lesion and contralateral mirror area were compared.The correlations were analyzed between rADC value and rD,rD*,rf values respectively,as well as between rCBF value and rD,rD*,rf values respectively.Results Quantitative analysis showed significant decreases of ADC,D,D*,f and CBF values in the brain infarction lesion compared with those in the contralateral mirror area (all P＜0.05).There were positive correlations between rADC value and rD,rf values (r=0.687,0.601,P=0.005,0.018).And the positive correlation was found between rCBF value and rf value (r=0.581,P=0.022).Conclusion IVIM imaging can concurrently provide the perfusion and diffusion informations of subacute brain infarction patients,which is helpful to further elucidate the mechanisms of subacute brain infarction.
ABSTRACT
Objective To study the value of three-dimensional pseudo-continuous arterial spin labeling(3D pCASL) for estimating collateral flow after middle cerebral artery(MCA) stenosis.Methods 3D pCASL was performed in 28 cases of negative diffusion weighted imaging(DWI) patients with MCA stenosis for estimating collateral vessels formation.The post-labeling delay(PLD) of 3D pCASL was set to 1.5 s and 2.5 s.The cerebral blood flow (CBF) of 3D pCASL with two PLD was calculated by AW workstation respectively.Nineteen normal persons were regarded as the control group.The 95% confidence interval of the ratio of left/right side of CBF of control group was set as reference value.The characteristic of the ratio of stenosed/contralateral side of CBF was analyzed.The characteristics of collateral flow was investigated with digital subtraction angiography(DSA).Results Abnormal perfusion was found in 28 patiens.Two types of abnormal perfusion were found, including typeⅠ: rCBF(PLD=1.5 s) decreased,rCBF(PLD=2.5 s) was normal (n=16);typeⅡ:rCBF(PLD=1.5 s) decreased,rCBF(PLD=2.5s) decreased (n=12).On brain DSA, abundant of collateral flow supply was found in 16 patients with typeⅠabnormal perfusion,whereas deficiency of collateral flow supply was found in 12 patients with typeⅡ.Conclusion 3D pCASL with two PLDs may provide important reference value for estimating collateral flow after middle cerebral artery stenosis.
ABSTRACT
BACKGROUND: There are many reports on treatment of senile memory impairment with huperzine A, aniracetam, ginkgobiloba, etc. But, a strict double-blind and double-dummy design is deficit during experiment.OBJECTIVE: With cognition, symptoms of yin deficiency of liver and kidney and memory taken as observed indexes, double-blind and doubledummy method was used to observe the therapeutic effects of Chinese drug naolibao on senile memory impairmentof yin deficiency of liver and kidney. DESIGN: Prospective clinical experiment with randomized controlled double-blind and double-dummy method was designed. SETTING: Department of Neurology of Affiliated Hospital with Changchun College of Chinese Medicine, Department of Medicament of 2nd Clinical Hospital Affiliated to Jilin University.PARTICIPANTS: Totally 80 cases of memory impairment were from the clinic of Department of Neurology of affiliated Hospital with Changchun College of Chinese Medicine from April to December 2000. They were aged varied from 40 to 75 years, with mild non-constant poor memory, differentiated as yin deficiency of liver and kidney and diagnosed as questionable dementia in Chinese medicine, scored as 0 or 0.5 according to Clinical Dementia Assessment Scale (CDAS) and their integrals were > 17 (illiteracy) or > 20 (elementary-school educated) or > 23 (juniorschool educated) and < 30 according to MMSE (mini mental status examination).METHODS:The patients were randomized into experimental group (n=43) and the control (n=37). In experimental group, naolibao wan was administrated, composed of dihuang (Radix Rehmanniae), tusizi (SemenCuscutae), digupi (Cortex Lycii), yuanzhi (Radix Polygalae), shichangpu (Rhizoma Acori Graminei) and fuling (Poria), 4 pills/times, 3 times/day,and piracetan blank tablet was given, 2 tablets/time, 3 times/d. In the control, piracetan tablet 400 mg/tablet was prescribed, two tablets/time,3 times/day and naolibao blank pill was administrated, 4 pills/time,3 times/day. The course of treatment was 6 weeks. On observed spot,named base-line spot (before treatment) and terminal spot (after treatment), the integrals were examined and recorded on symptoms, physical signs and neuropsychology successively. Follow-up visit was carried on for the cases with remarkable effects. Therapeutic effects of syndromes in Chinese medicine were based on the evaluating criteria of Clinical Plan of Treatment with Naolibao Wan for Senile Memory Disturbance of Yin Deficiency of Liver and Kidney. In comparison of decreased symptomatic integral after treatment with average symptomatic integral before treatment, remarkable effect: ≥ 2/3, effect: 1/3-2/3, no effect: ≤ 1/3. The therapeutic effects on cognition and memory were assessed by the formula [(integral after treatment-integral before treatment)÷integral before treatment] ×100%. Clinical control: ≥ 85%, remarkable effect:≥ 50%, effect: ≥ 20% and no effect: ≥ 20%.MAIN OUTCOME MEASURES: ① Comparison before and after treatment of yin deficiency of liver and kidney in two groups. ② Comparison of integrals before and after treatment for yin deficiency of liver and kidney of two groups. ③ Comparison of evaluation of every index for memory in two groups. ④ Results of follow-up visits for the cases with remarkable effects. ⑤ Harmful accident and side effects.RESULTS: Totally 43 cases in experimental group and 37 cases in the control were all employed in result analysis. ① Comparison before and after treatment of yin deficiency of liver and kidney in two groups: The reduced score in differentiation of symptoms, improvement of severity of yin deficiency of liver and kidney and promoted therapeutic effects on syndrome in experimental group were superior to those in the control, indicating significant difference (P < 0.05-0.01). ② Comparison of integrals before and after treatment for yin deficiency of liver and kidney of two groups: The improvement of dream-disturbed sleep, tinnitus and deafness in experimental group was superior to that in the control, indicating significant difference (P < 0.05-0.01). ③ Comparison of evaluation of every index for memory in two groups: The improvement of immediate recall and retarded recall in experimental group was superior to that in the contol,indicating significant difference (P < 0.05-0.01). ④ Results of follow-up visits for the cases with remarkable effects: Three months later, the disease was not aggravated among the cases with remarkable effects in two groups.⑤ Harmful accident and side effects: After treatment, there was no abnormal alternation and harmful reaction for safe indexes compared with those before treatment, such as blood routine, urine routine, feces routine, liver function, kidney function, etc.CONCLUSION: Naolibao wan improves memory, immediate recall, recog nition, dream-disturbed sleep, tinnitus and deafness for aged people, which is superior to piracetan tablet and it is safe and reliable in treatment.