CPMG法パルス系列による脳血管性障害のNMR-CT

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  • NMR-CT of Cerebrovascular Diseases using Pulse Sequence of Carr-Purcell-Meiboom-Gill Method

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Nuclear magnetic resonance-computed tomography (NMR-CT) findings of 114 cases of cerebrovascular diseases are reported. The NMR-CT used for this study was a product of Bruker Company in West Germany. It has a 0. 15 tesla resistive magnet, using the pulse sequence of the Carr-Purcell-Meiboom-Gill (CPMG) method. Intracerebral hematoma showing iso or low density on X-ray CT could be detected by NMR-CT in the subacute stage and even in the chronic stage. T1 and T2 relaxation times (T1, T2) of hematoma showed prolongation as time passed from about 2 weeks after the onset. NMR-CT detected small or lacunar infarctic lesions at the basal ganglia, the brain stem or the posterior fossa. Prolongations of T1 and T2 in infarctic foci were more marked than in hematomas. In two cases of transient ischemic attack, the responsible lesions were detected by NMR-CT, but no abnormality was found on X-ray CT at the same time. Moreover, as disappearance of the abnormal image and normalization of T1 and T2 in these foci were noted by followup NMR-CT after bypass surgery, it was suggested that these lesions were reversible and might be a critical low perfusion area, the so-called ischemic penumbra. NMR-CT findings in moyamoya disease were the same as those obtained by X-ray CT. However, slightly ischemic lesions might be detected by NMR-CT. Therefore, operative indications and effectiveness for ischemic moyamoya disease might be decided by NMR-CT. For arteriovenous malformations (AVMs), NMR-CT was an excellent diagnostic method because the extent of the lesions was easily recognized, and dilated vessels were depicted as low or no signal intensity areas without using contrast media. Three dimensional observation of brain tissues surrounding the AVM was possible by NMR-CT. These areas were depicted as T1 and T2 prolonged regions on calculated NMR images. This finding may indicate ischemic or necrotic changes due to the blood steal phenomena.<BR> 1H-NMR-CT is very useful in diagnosing various cerebrovascular diseases since these pathological states have close relations to water metabolism in the brain. Moreover, the CPMG method may be the most diagnostic pulse sequence for clinical cases in the neurosurgical field.

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