目的 探讨磁共振3D pCASL灌注 成像对烟雾病颞浅动脉-大脑中动脉(STAMCA)搭桥术术前术后血流动力学改变的 评价效果。方法 选择在本院神经外科行 STA-MCA术的烟雾病患者作为研究对象， 并对其进行PLD时间分别为1.5s和2.5s的 3D pCASL磁共振灌注成像扫描，观察患 者的术前术后ASL灌注表现，分析不同PLD 时间，术侧与非术侧术前术后绝对CBF值 与相对CBF的变化情况。结果 44例患者 中，行左侧搭桥24例，右侧搭桥20例，行 第一次搭桥术30例，行第二次搭桥术14 例，通过分析长短PLD时间的ASL血流灌注 图，术前术后均能够动态观察脑血流的动 态灌注情况。不同的PLD时间，术侧与非 术侧的术后CBF值都明显升高，术前术后 的差异有明显的统计学意义(P<0.05)。术 前不同的PLD时间，术侧与非术侧的差异 没有统计学意义(P>0.05),术后术侧-CBF 值比非术侧-CBF值明显升高，差异有统计 学意义(P<0.05)。术侧与非术侧的比值为 相对脑血流量(rCBF)，不同的PLD时间， 术后rCBF值比术前明显升高，术前术后的 差异有统计学差异(P<0.05)。术前术后， PLD=1.5s与PLD=2.5s的rCBF值均没有统计 学差异(P>0.05)。结论 双延迟3D pCASL 可以动态显示烟雾病患者血流动力学的改 变，可以有效的评估烟雾病患者STA-MCA 术术后脑血流的改善情况，对评估烟雾病 患者血管重建术后的血流动力学改变具有 重要的意义。

Objective To evaluate the effect of 3D pCASL on hemodynamics in patents with moyamoya disease before and after STA-MCA revascularization. Methods 44 patients with moyamoya disease treated by STA-MCA revascularization in our hospital were selected as the subjects and the brain perfusion imaging was performed by MRI 3D pCASL perfusion with PLD of 1.5s and 2.5s. The ASL perfusion images of the patients were observed before and after operation, and the cerebral blood flow (CBF) and relative cerebral blood volume(rCBF) were analyzed between pre-operative and postoperative, and between operative side and non-operative side in the cerebral ischemia area. Results Of the 44 patients, 24 underwent left bypass, 20 right bypass, 30 first bypass and 14 second bypass. The dynamic changes of cerebral blood flow perfusion before and after operation were observed by ASL perfusion images . In different PLD time, the CBF value of the operative side and the non-operative side increased significantly on postoperative, and the difference between the pre-operative and post-operative had significant statistical significance (P<0.05). There was no significant difference in operative side and non-operative side on pre-operative(P>0.05). The CBF value of operative side was significantly higher than that of non-operative side on post-operative(P<0.05). The ratio of the operative side to the non-operative side was relative cerebral blood flow (rCBF). In different PLD time, the rCBF value increased significantly after operative. The difference between the pre-operative and post-operative was statistically significant (P<0.05). Before and after operation, there was no significant difference in rCBF values between PLD=1.5s and PLD=2.5s (P>0.05). Conclusion Dual-delay MRI 3D pCASL can dynamically display the hemodynamic changes in patients with moyamoya disease, and can effectively evaluate the improvement of cerebral blood flow in patients with moyamoya disease after STAMCA. It is of great significance to evaluate the hemodynamic changes in patients with moyamoya disease after vascular reconstruction.