CT灌注评价高碳酸血症模型下正常大鼠脑组织血流动力学变化

目的探讨CT灌注评价高碳酸血症模型下正常大鼠脑组织血流动力学变化的可行性;研究大鼠CT灌注参数变化率与α-SMA表达之间的相关性。方法 10只雄性SD大鼠,体质量250～300g,在吸入空气和吸入高浓度CO2混合气体(10%CO2和90%空气组成)后15min,分别使用GE16层Light Speed CT扫描仪对大鼠脑尾状核层面进行CT灌注扫描,原始图像经GE ADW4.2工作站Perfusion3.0脑部灌注软件处理后产生灌注曲线及伪彩图像,两次扫描前均测定大鼠的血液CO2分压、pH值等血气分析指标。检查结束后24h内,大鼠取脑固定,在尾状核中心层面切片,进行脑组织HE染色及鼠特异性SMA抗体免疫组化染色。应用SPSS11.5统计学软件进行分析:采用配对t检验,比较正常大鼠右侧尾状核在吸入空气和吸入高浓度CO2混合气体后CT灌注参数脑血容量(CBV)、脑血流量(CBF)、血管表面通透性(PS)和平均透过时间(MTT)的变化有无差异;采用Pearson相关分析分别检测大鼠右侧尾状核的SMA阳性血管染色计数与灌注参数CBV和CBF在CO2分压升高前后的变化率相关性。结果所有大鼠在吸入含10%CO2和90%空气的混合气体15min后,动脉血CO2分压均明显升高(t=9.39,P0.001),血浆pH值降低(t=13.49,P0.001)。正常SD大鼠右侧基底节区CBV、CBF、PS每100g组织分别为(10.28±4.01)mL、(304.95±88.77)mL/min、(0.26±0.37)mL/min,MTT值为(1.48±0.07)s;吸入10%CO2和90%空气的混合气体后右侧基底节区CBV、CBF值明显增加,每100g组织分别为(19.25±8.42)mL(t=4.92,P=0.001)和(507.33±167.94)mL/min(t=6.75,P0.001);吸入混合气体前后CBV、CBF增加百分比分别为(87.14±46.45)%、(65.75±22.05)%;PS及MTT变化不显著(P均0.05)。大鼠脑组织α-SMA阳性染色血管计数为(12.7±3.23)条/高倍视野。Pearson相关分析显示,正常脑组织的CBV和CBF变化率与其α-SMA阳性计数之间呈显著相关(r分别为0.652和0.890,P均0.05)。结论 CT灌注技术在改变血液CO2分压的条件下可以反映脑组织血流动力学变化;大鼠正常脑组织高碳酸血症前后CT灌注参数变化率与成熟血管数量相关。     

大鼠C6脑胶质瘤CT灌注成像及其与MVD的相关性研究

目的:采用64层MSCT灌注成像(CTP)与免疫组化染色法定量观测大鼠C6脑胶质瘤的血管生成特征.方法:成年Wistar大鼠40只,采用立体定向仪进行C6细胞脑内接种,建立大鼠C6脑胶质瘤模型.每次随机抽取10只接种鼠分别对应于5-10d,10-15d,15-20d三个时间段行CTP及免疫组化微血管定量测定,观测大鼠C6脑胶质瘤血流灌注参数的动态变化规律,及其与免疫组化微血管密度(MVD)之间的相关性.结果:大鼠脑内C6细胞接种后5-10d,瘤内即有新生微血管,并随时间而继续增殖,于10-15d达到高峰,并稳定在一较高水平,15-20d肿瘤微血管有所下降.肿瘤组织毛细血管通透性在5-10d内即有明显增高,10d以后继续增高,15d以后增高显著,并在20d内无下降趋势.Pearson相关分析表明大鼠C6脑胶质瘤CBV、CBF与MVD呈显著线性正相关(CBF=0.730,rCBV=0.917,P<0.01),而PS、MTT值与MVD不具相关性(rPS=0.067,rMTT=0.002,P>0.05).结论:CTP各种参数中,PS值是反映肿瘤血管性质的较好指标,而CBF,CBV是反映肿瘤微血管数量的敏感性指标,CTP可以准确反映大鼠C6脑胶质瘤的血管生成.     

兔脑微栓塞模型脑血流动力学的CT灌注动态变化

目的探讨兔脑微栓塞模型CT灌注成像（CT perfusion imaging,CTPI）脑血流动力学的动态变化规律。方法 30只新西兰兔,随机分成两组,A组：假手术对照组5只,B组：微栓塞组25只。经颈外动脉向颈内动脉注入直径约0.5 mm的SiO2颗粒10枚,分别于栓塞后30 min、3 h、6 h、12 h及24 h行CTPI,24 h处死动物取脑组织行HE染色。根据HE染色结果将模型分为缺血组和梗死组,分别观察其脑血流量（cerebral blood flow,CBF）、脑血容积（cerebral blood volume,CBV）和平均通过时间（mean transit time,MTT）的动态变化规律。结果 A组CTPI及HE染色均未见明显异常。B组3只因实验意外死亡,1只因下肢静脉穿刺失败导致CTPI失败,21只行CTPI,其中18只灌注异常,3只未见明显异常。18只灌注异常的兔中,HE染色10只脑梗死,7只脑缺血,1只未见明显异常。30 min时7只缺血兔脑不同程度低灌注,表现为CBF降低,MTT延长,CBV无显著变化,3～6 h低灌注进一步加重,CBV值略降低,12 h低灌注不同程度恢复,24 h进一步恢复。30 min时10只梗死兔脑明显低灌注,表现为CBF及CBV显著降低,MTT显著延长,3只兔低灌注分别在3 h、6 h及12 h不同程度恢复,然后下一时间又迅速降低并随着时间延长进一步加剧,其余7只兔低灌注程度随时间延长逐渐加剧或在一定水平上波动。结论脑缺血3～6 h低灌注最明显,12～24 h低灌注不同程度恢复,而脑梗死随时间延长低灌注程度不断加重或一过性恢复后再次加重。脑缺血的特征是CBF和CBV的不匹配,缺血组织CBF显著降低,CBV无显著变化,而脑梗死则表现为这两个参数的一致性下降。     

正常大鼠脑CT灌注成像的可重复性研究

目的:评价多层螺旋CT灌注成像对正常大鼠脑血流动力学观测结果的可重复性.方法:分别对10只健康Wistar大鼠间隔2d进行CT灌注扫描,两组原始灌注数据由2名放射科医师分别进行5次后处理得出CBF、CBV和MTT值.分析观察者内和观察者间观测结果的可重复性,以及对同一组研究对象间隔2d两次检查结果的一致性.结果:多层螺旋CT对Wistar大鼠脑所采集的灌注原始数据在观察者内和观察者间观测结果均无统计学差别(P＞0.05),并具有很好的线性(CBF和CBV值)或等级(MTT值)正相关(P＜0.01).对同一组研究对象间隔2d的两次CT灌注成像结果也存在同样好的重复性.结论:多层螺旋CT灌注成像对于Wistar大鼠脑部血流动力学观测具有很高的精密度和准确性,完全适于小型动物模型脑部血流动力学的研究.     

正常大鼠脑血流动力学的CT灌注成像研究

目的:采用多层螺旋CT灌注成像探讨正常大鼠脑血流动力学特征.方法:对15只健康Wistar大鼠进行CT灌注扫描,定量测定全脑不同区域的血流动力学参数,分析正常Wistar大鼠脑血流动力学特征.结果:正常Wistar大鼠脑部不同区域的血流动力学参数存在较大差异(P＜0.05或0.01),Wistar大鼠的CBF和CBV值以小脑最高,其次是基底节区和延髓,大脑皮质的CBF和CBV值较低:而MTT值在Wistar大鼠脑部各区域比较接近,均值比较无统计学意义(P＞0.05).结论:多层螺旋CT可用于定量评价Wistar大鼠脑组织的血液动力学特征,完全适用于小型动物模型脑部血流动力学的研究.     

CT灌注成像技术用于重型颅脑损伤患者脑室型颅内压探头植入的临床价值评估

目的:探讨CT灌注成像技术用于重型颅脑损伤患者脑室型颅内压(Intracranial Pressure, ICP)探头植入的临床价值。方法:选取60例重型颅脑损伤患者,均行患侧开颅去骨瓣减压和颅内压监测探头置入术。其中,行普通型颅内压监测探头置入术28例,脑室型颅内压监测探头置入术32例。比较两组术后甘露醇应用剂量和应用时间,术后局部脑血流参数区域脑血流量(regional Cerebral Blood Flow, r CBF)、相对脑血容量(relative Cerebral Blood Volume, r CBV)、平均通过时间(Mean Transit Time, MTT)、对比剂达峰时间(time to peak, TTP)恢复情况。结果:脑室型颅内压监测组患者术后应用甘露醇的剂量和天数较普通颅内压监测组明显缩短(P0.05),术后3个月随访提示脑室型ICP监测组预后良好比例较普通型ICP组显著增加(P0.05)。并且螺旋CT灌注成像结果提示脑室型颅内压监测组患者术后局部脑血流参数r CBF、r CBV、MTT、TTP恢复情况明显优于普通型颅内压监测组(P0.05)。结论:重型颅脑损伤患者应用脑室型颅内监测探头改变了脱水剂在临床应用中的治疗模式,通过螺旋CT灌注成像检测患者损伤部位的r CBF、r CBV、MTT和TTP可评估脑损伤的程度以及预后,对重型颅脑损伤的临床治疗和改善患者预后具有重要意义。     

滚压泵在乳猪肺灌注模型建立中的应用

目的通过滚压泵建立一种操作简单的猪隔离肺持续灌注和缺血再灌注模型,并比较两种灌注方法对肺的损伤。方法12只乳猪随机分为缺血再灌注组（对照组）和持续灌注组（实验组）。分别在左、右心耳以及肺动脉插管。滚压泵将贮血器中的灌注液泵入肺动脉,灌注双肺后再通过左心耳将灌注液引流回贮血器,建立猪肺灌注模型。对照组双肺停止灌注90min后灌注30min,实验组双肺持续灌注120min,灌注流量均为80mL/kg.min。测定实验前后的肺静态顺应性以及灌注液中TNF-α、IL-6变化。测定肺组织湿干比并进行电镜观察。结果实验组肺静态顺应性（实验组6.14±1.17mL/cmH2O,对照组7.89±0.94mL/cmH2O,p=0.017）、湿干比（对照组5.18±0.97,实验组3.84±1.08,P=0.048）、TNF-α指标均优于对照组（实验组0.80±0.26ng/mL,对照组0.52±0.15ng/mL,P=0.044）（P〈0.05）,电镜下的肺损伤程度轻于对照组。结论通过滚压泵建立猪肺持续灌注和缺血再灌注模型具有操作简便的特点。持续性非搏动灌注较之缺血再灌注对肺的损伤更轻。     

立体定向建立大鼠C6脑胶质瘤模型

目的应用不同C6细胞数量接种大鼠脑内建立大鼠脑胶质瘤模型,观察其生长特性,比较各种接种量的优劣。方法分别取1·0×105个/10μl,1·0×106个/10μl,1·0×107个/10μl体外培养的大鼠C6胶质瘤细胞单细胞悬液,立体定向接种于Wistar大鼠脑右侧尾状核区,在整体、组织、细胞、蛋白4个水平对各种接种量进行比较。结果各种接种量的实验组成瘤率均为100%,未见颅外转移病灶,在组织病理学上接近人脑胶质瘤,瘤细胞病理性核分裂像多见,C-erbB1和S-100B等神经胶质瘤常见蛋白强阳性表达,瘤组织内有丰富的微血管以及出血和坏死。结论C6细胞接种Wistar大鼠建立脑胶质瘤动物模型,成瘤率高,颅内生长稳定,肿瘤组织病理学及形态学特性与人脑胶质瘤相似。可作为临床胶质瘤基础研究的理想模型。实验过程部分时段各种接种剂量肿瘤生长速度差异有显著性,可根据病因学、实验治疗或药效学等不同研究需要选择不同接种量。     

CT脑灌注剂量下X射线对体外培养的骨髓间质干细胞的影响

观察大鼠CT脑灌注剂量下的X射线照射对体外培养的骨髓间质干细胞的影响.体外大鼠培养骨髓间质细胞,分为照射组和未照射对照组,照射组细胞分别进行1～5次大鼠脑灌注条件下CT扫描.两组细胞分别做生长曲线,运用流式细胞仪检测细胞周期改变情况,以及行噻唑蓝(3-(4,5)-dimethylthiahiazo(-z-y1)-3,5-di-phenytetrazolium romide,MTT)法检测细胞凋亡情况.5次大鼠脑灌注CT扫描下照射组细胞活性及凋亡情况与对照组细胞差异无统计学意义.常规大鼠脑灌注CT扫描对骨髓间质干细胞活性无影响.     

氧自由基与脑胶质瘤瘤周水肿关系的实验研究

目的：探讨自由基和脑胶质瘤瘤周水肿的关系。方法：体外培养大鼠C6脑胶质瘤细胞株,采用立体定向技术将细胞株接种在右侧尾状核,建立大鼠脑胶质瘤模型,共60只,术后5天将荷瘤大鼠随机分为3组（EDA高剂量组,EDA低剂量组和对照组）,每组各20只,每组10只用来测定荷瘤大鼠瘤周脑组织含水量、SOD活性及MDA含量,剩余10只用来观察荷瘤大鼠生存时间。结果：EDA干预组荷瘤大鼠瘤周脑组织含水量下降,SOD活性增高,MDA含量下降,以EDA高剂量组更为显著。各组荷瘤大鼠瘤周脑组织含水量与SOD活性呈负相关,而与MDA含量呈正相关。且EDA组荷瘤大鼠生存时间延长。结论：由基参与大鼠脑胶质瘤瘤周水肿的形成,自由基清除剂能够减轻大鼠脑胶质瘤瘤周脑组织水肿。     

CT Perfusion with Acetazolamide Challenge in C6 Gliomas and Angiogenesis

Background

This study was performed to investigate the correlation between CT perfusion with acetazolamide challenge and angiogenesis in C6 gliomas.

Methods

Thirty-two male Sprague-Dawley rats were evaluated. The rats were divided randomly to four groups: eight rats with orthotopically implanted C6 gliomas at 10-days old (Group A), eight rats with gliomas at 14-days old (Group B), eight rats with gliomas at 18-days old (Group C), eight rats with orthotopically injected normal saline served as controls. CT perfusion was performed before and after administration of acetazolamide. Changes in perfusion parameters due to acetazolamide administration were calculated and analyzed.

Results

Elevated carbon dioxide partial pressure and decreased pH were found in all 32 rats post acetazolamide challenge (P<0.01). Cerebral blood flow_{pre-challenge} was increased in group C (95.0±2.5 ml/100g/min), as compared to group B (80.1±11.3 ml/100g/min) and group A (63.1±2.1 ml/100g/min). Cerebral blood flow percentage changes were detected with a reduction in group C (54.2±4.8%) as compared to controls (111.3±22.2%). Cerebral blood volume _{pre-challenge} was increased in group C (50.8±1.7ml/100g), as compared to group B (45.7±1.9 ml/100g) and group A (38.2±0.8 ml/100g). Cerebral blood volume percentage changes were decreased in group C (23.5±4.6%) as compared to controls (113.5±30.4%). Angiogenesis ratio = [(CD105-MVD) / (FVIII-MVD)] ×100%. Positive correlations were observed between CD105-microvessel density, angiogenesis ratio, vascular endothelial growth factor, proliferation marker and cerebral blood flow_{pre-challenge}, cerebral blood volume _{pre-challenge}. Negative correlations were observed between CD105-microvessel density and cerebral blood flow percentage changes (P<0.01, correlation coefficient r=-0.788), cerebral blood volume percentage changes (P<0.01, r=-0.703). Negative correlations were observed between angiogenesis ratio, vascular endothelial growth factor, proliferation marker and cerebral blood flow percentage changes, cerebral blood volume percentage changes.

Conclusion

Our findings suggest that CT perfusion with challenge can provide new insight into non-invasive assessment of rat C6 glioma angiogenesis.     

帕金森病合并抑郁与脑血流灌注的关系及经颅磁刺激的影响

目的：应用CT灌注成像技术观察帕金森病合并抑郁患者局灶脑血流灌注的特点,进一步探讨抑郁症发生与脑血流的关系.方法：将41例帕金森患者根据是否合并抑郁症分为帕金森病组22例、帕金森病合并抑郁症者为抑郁组19例、其中抑郁组分为经颅磁刺激（rTMS）治疗前组、治疗后组,3组均进行CT局部脑血流灌注显像,半定量分析各脑区血流灌注情况.结果：帕金森合并抑郁症组患者双侧额叶、颞叶和基底节的脑血流量测定（CBF）较帕金森病组显著下降（P＜0.05）;抑郁组左、右侧脑血流低灌注存在不对称性,左侧额叶、顶叶的CBF较右侧显著下降（P＜0.01）;rTMS治疗后脑血流灌注较治疗前改善,HAMD评分改善（P＜0.05）.结论：帕金森患者存在局灶性脑血流灌注降低,合并抑郁症患者额、顶叶下降更明显,经颅磁刺激治疗后脑血流低灌注改善.     

Influence of Thin Slice Reconstruction on CT Brain Perfusion Analysis

Objectives

Although CT scanners generally allow dynamic acquisition of thin slices (1 mm), thick slice (≥5 mm) reconstruction is commonly used for stroke imaging to reduce data, processing time, and noise level. Thin slice CT perfusion (CTP) reconstruction may suffer less from partial volume effects, and thus yield more accurate quantitative results with increased resolution. Before thin slice protocols are to be introduced clinically, it needs to be ensured that this does not affect overall CTP constancy. We studied the influence of thin slice reconstruction on average perfusion values by comparing it with standard thick slice reconstruction.

Materials and Methods

From 50 patient studies, absolute and relative hemisphere averaged estimates of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and permeability-surface area product (PS) were analyzed using 0.8, 2.4, 4.8, and 9.6 mm slice reconstructions. Specifically, the influence of Gaussian and bilateral filtering, the arterial input function (AIF), and motion correction on the perfusion values was investigated.

Results

Bilateral filtering gave noise levels comparable to isotropic Gaussian filtering, with less partial volume effects. Absolute CBF, CBV and PS were 22%, 14% and 46% lower with 0.8 mm than with 4.8 mm slices. If the AIF and motion correction were based on thin slices prior to reconstruction of thicker slices, these differences reduced to 3%, 4% and 3%. The effect of slice thickness on relative values was very small.

Conclusions

This study shows that thin slice reconstruction for CTP with unaltered acquisition protocol gives relative perfusion values without clinically relevant bias. It does however affect absolute perfusion values, of which CBF and CBV are most sensitive. Partial volume effects in large arteries and veins lead to overestimation of these values. The effects of reconstruction slice thickness should be taken into account when absolute perfusion values are used for clinical decision making.     

SD大鼠与Wistar大鼠脑胶质瘤动物模型的建立及比较

目的比较利用SD大鼠、Wistar大鼠建立脑胶质瘤动物模型的不同,为研究脑胶质瘤的发病机制及治疗方法提供操作平台。方法利用立体定向仪建立SD大鼠、Wistar大鼠大脑皮层接种C6细胞（2.5×105个细胞/只）,建立脑胶质瘤动物模型,利用组织病理学、免疫组织化学以及核磁共振成像等技术,比较两种动物模型在成瘤率、肿瘤生长状况、死亡率以及动物一般情况等方面的异同。结果SD大鼠组、Wistar大鼠组的成瘤率均为100%,两组均未见转移;但SD大鼠组肿瘤成瘤时间较长,且部分肿瘤有自愈倾向,而Wistar大鼠组则未出现类似情况。结论Wistar大鼠大脑皮层脑胶质瘤动物模型的肿瘤性状更接近于人的脑胶质瘤,因此更适合探索和研究脑胶质瘤的发病机制和治疗方法;而SD大鼠的肿瘤由于性状类似转移瘤,且有自愈倾向,不适合作为上述相关研究的动物模型。     

Increased Perfusion in Normal Appearing White Matter in High Inflammatory Multiple Sclerosis Patients

PurposeAlthough cerebral perfusion alterations have long been acknowledged in multiple sclerosis (MS), the relationship between measurable perfusion changes and the status of highly active MS has not been examined. We hypothesized that alteration of perfusion can be detected in normal appearing white matter and is increased in high inflammatory patients.ResultsThirteen patients were classified as high-inflammatory. Compared to low-inflammatory patients, the high-inflammatory group demonstrated significantly higher CBV (p = 0.001) and CBF (p = 0.014) values. A mixed model analysis to assess independent variables associated with CBV and CBF revealed that white matter lesion load and atrophy measurements had no significant influence on CBF and CBV.ConclusionThis work provides evidence that high inflammatory lesion load is associated with increased CBV and CBF, underlining the role of global modified microcirculation prior to leakage of the blood-brain barrier in the pathophysiology of MS. Perfusion changes might therefore be sensitive to active inflammation apart from lesion development without local blood–brain barrier breakdown, and could be utilized to further assess the metabolic aspect of current inflammation.     

PI3K通路抑制剂LY294002对人脑胶质瘤细胞株U87细胞衰老和凋亡的影响

目的:PI3K/Akt信号通路是与胶质瘤发生发展密切相关的核心通路之一,LY294002是该通路的特异性抑制剂。本研究通过探讨PI3K通路抑制剂LY294002对U87胶质瘤细胞系细胞衰老及凋亡的影响,从而为胶质瘤患者治疗的新策略奠定理论基础。方法:将体外培养的人脑胶质瘤U87细胞株分为DMSO处理的对照组和LY294002(100μM)处理的实验组,采用β-半乳糖苷酶染色和流式细胞术的方法,分别检测并比较两组肿瘤细胞衰老和凋亡的情况。结果:LY294002处理组U87胶质瘤细胞的衰老指数(32.20±4.46%)显著高于DMSO对照组(3.40±1.61%,t=6.254,P0.001)。另外,与DMSO对照组相比,凋亡蛋白caspase-3mRNA的表达在LY294002处理组胶质瘤细胞中显著上调(t=8.923,P0.05)。LY294002处理组肿瘤细胞的凋亡指数(80.10±4.832%)明显高于DMSO对照组(4.260±1.073%,t=8.923,P0.05)。结论:LY294002既能够诱导肿瘤细胞衰老,又能够诱导肿瘤细胞凋亡,然而其诱导胶质瘤细胞凋亡的能力占据主导地位,为其发挥抗胶质瘤效应的主要途径。另外,在LY294002的持续作用下,部分衰老的肿瘤细胞或许会发生凋亡。这些结论为为临床增强胶质瘤患者的联合化疗奠定了理论基础。