烟雾病的后循环分级与手术疗效及灌注的相关性
李魁元 李红伟 杨 波 董 阳 曹 磊 尤浩君
郑州大学第一附属医院，河南 郑州 450052
通信作者：杨波，Email：2491492624@qq.com
【摘要】 目的 提供一种烟雾病后循环分级方法，探究其与前循环、手术疗效及大脑灌注的相关性。方法 采用回顾性研究，大脑前循环用铃木分期代表，铃木分期 1~6 期分别赋值 1~6 分。后循环代偿分级为矢状位解剖上以中脑中心为原点，经胼胝体膝与胼胝体体部交界处、胼胝体体部与胼胝体压部交界处分别做射线，将大脑半球划分为三等份，按照烟雾病患者 DSA 图像 VA 从后往前所能达到的区域分别定义为 0、1、2、3 级，分别赋值 0、1、2、3 分。术后手术疗效采用松岛分级，大脑半球灌注水准采用全脑动脉自旋标记技术（ASL）评估。统计入组患者术前铃木分期、后循环代偿分级、术前大脑血流量（ASL-CBF）、术后松岛分级、术后 ASL-CBF，算出灌注差（术后 ASL-CBF—术前 ASL-CBF）。结果 后循环代偿分级与铃木分期呈正相关（r=0.502，P<0.01），与术后松岛分级无明显相关性（P=0.19），与 ASL 灌注差无明显相关性（P=0.651），但与术前 ASL-CBF 呈正相关（r=0.337，P<0.05）。结论 该后循环代偿分级与铃木分期有相关性，且与术前灌注水平相关，可能有更好的临床实用性。
【关键词】 烟雾病；后循环；铃木分期；松岛分级；脑灌注
【中图分类号】 R743 【文献标识码】 A 【文章编号】 1673-5110 （2022） 03-0265-05
DOI：10.12083/SYSJ.220155
Correlation between posterior circulation classification of moyamoya disease and surgical efficacy and perfusion
LI Kuiyuan，LI Hongwei，YANG Bo，DONG Yang，CAO Lei，YOU Haojun
The First Affiliated Hospital of Zhengzhou University，Zhengzhou 450052，China
Corresponding author：YANG Bo，Email：2491492624@qq.com
【Abstract】 Objective To provide a classification method for posterior circulation in moyamoya disease，and to explore its correlation with anterior cerebral circulation，surgical efficacy and cerebral perfusion. Methods The anterior cerebral circulation was represented by Suzuki stage. Suzuki stages 1-6 were assigned 1-6 points. Compensatory of posterior circulation stages was strat from mesencephalon center on sagittal of anatomy. Crossing the junction of genu of corpus callosum and body of corpus callosum，the body of corpus callosum and the splenium of corpus callosum. Dividing the brain hemispheres into three equal parts. According to the DSA images of moyamoya disease，the regions that VA could reach from the back to the front were defined as stages 0，1，2，and 3，assigning them as 0，1，2，and 3 points. Postoperative efficacy was evaluated by Matsushima grades. Cerebral hemispherical perfusion level was assessed by whole cerebral artery spin labeling technique（ASL）. Collecting the data of suzuki stages，compensatory of posterior circulation stages，preoperative ASL-cerebral blood flow（ASL-CBF），Matsushima grades and postoperative ASL-CBF. The difference in perfusion was calculated （postoperative ASL-CBF-preoperative ASL-CBF）. Results There was a positive correlation between compensatory of posterior circulation stages and Suzuki stages，r=0.502，P<0.01. There was no significant correlation between compensatory of posterior circulation stages and postoperative Matsushima grades，P=0.19. There was no significant correlation between compensatory of posterior circulation stages and the differences of ASL perfusion，P=0.651. However，it was positively correlated with preoperative ASL-CBF，r=0.337，P<0.05. Conclusion The compensatory of posterior circulation stages is correlated with cerebral anterior circulation. It is correlated with preoperative perfusion level. This stages may have better clinical practicality.
【Key words】 Moyamoya disease; Posterior circulation; Suzuki stage; Matsushima classification;Cerebral perfusion
