基于磁共振多技术成像的脑泡型包虫病边缘带血供机制研究

Cerebral alveolar echinococcosis （CAE）reproduces infiltratively like malignant tumor. It harms health of mankind seriously.China's 12th five-year plan proposed to implement the comprehensive prevention and control measures of echinococcosis clearly. The main mass can be demonstrated on various images. But to the mass blood supply and infiltrative zone, we know less，it is difficult to judge the actual bounds for conventional magnetic resonance imaging. It is difficult to determine the extent of surgical resection for CAE patients.There is currently still a lack of study，It is urgent to need a method to judge the actual bounds for CAE in clinical practice. On the basis of our former work, this application will use combine with conventional MRI and DCE-MRI and multi-b value DWI technique on brain of animal model of CAE and CAE patients, related blood supply data will be analyzed. then compare with pathology（including MVD）.And the CD34 microessel-density in corresponding organization will be detected by immunohistochemical method detection of mark in the lesions of surgical resection. Comprehensive index of pathology and imaging will be analyzed. This research will explore the correlation of the pathology and imaging two methods. This research focuses on blood supply and heterogeneity of infiltration zone of CAE, with DCE-MRI and multi-b value DWI，This research will explore infiltration zone of CAE nearly close to the actual infiltrating scope, to distinguish inflammatory reaction area，to provide reliable images for clinic . It has important guidance and favourable applicative perspective in high incidence rate area of hydatid disease.

脑泡状棘球蚴病象恶性肿瘤样侵润性繁殖，对人体危害极大。国家‘十二五’规划明确提出要落实包虫病的综合防治措施。以往对于脑泡状棘球蚴病的影像学研究主要集中于显示其影像学特征，对于病灶的边缘区域和血供所知甚少，常规的影像学方法（包括常规MRI）难以判断其实际界限，以至于手术范围难以判定，临床上迫切需要一种方法来判断病灶的实际范围。在前期研究基础上，本次申请拟通过常规磁共振、动态增强扫描成像和多b值扩散加权成像技术，对脑泡状棘球蚴病动物模型和患者进行血供相关指标分析，并对病灶和边缘带用免疫组织化学方法检测CD34标记的微血管密度，影像综合指标和组织病理（微血管密度）进行对照研究,本研究旨在通过脑泡状棘球蚴病边缘带血供和异质性来探索浸润带近可能接近实际的范围，区分炎性反应带并且探讨血供机制，为临床手术提供可靠的影像学依据。本项研究在包虫病高发的新疆地区，具有重要的临床指导意义。

脑泡状棘球蚴病象恶性肿瘤样侵润性繁殖，对人体危害极大。国家‘十二五’规划明确提.出要落实包虫病的综合防治措施。以往对于脑泡状棘球蚴病的影像学研究主要集中于显示其影像学特征，对于病灶的边缘区域和血供所知甚少，常规的影像学方法（包括常规MRI）难以判断其实际界限，以至于手术范围难以判定，临床上迫切需要一种方法来判断病灶的实际范围。在前期研究基础上，课题组成功建立羊脑泡型包虫病模型4例，建模成功率为40%，对上述病例行磁共振检查发发现病灶实质区、边缘带ADC值存在明显差异，边缘带NAA峰及NAA/Cr峰下降，且边缘带的ADC值与NAA/Cho、NAA/Cr比值存在负相关；动态增强扫描成像定量研究发现，CAE包虫实质区及边缘带血供丰富，血管分布杂乱，灶周边缘带存在泡型棘球蚴增殖浸润，且Ktrans在一定程度上能代表病灶的侵袭程度；多b值扩散加权成像定量研究发现病灶实质区与边缘带具有同质性，提示在泡球蚴病灶的边缘可能存在着决定泡球蚴病灶发生和发展的“浸润带”，且灶周水肿区5mm可能是浸润带的边界；磁共振灌注成像发现病灶边缘带因大量微血管增生致其灌注高于实质区，其定量指标rCBV、rCBF与CD34标记的微血管密度呈正相关；病理电镜下可见病灶内呈大片状坏死，周围可见纤维组织、大量炎性细胞增生及新生的微血管，与上述各技术定量指标所得结论一致。综上，病灶边缘带水分子扩散受限、大量微血管增生、呈高灌注病具有一定侵袭性，灶周0-5mm存在泡型棘球蚴浸润，该研究结果可为外科切除病灶范围提供影像学依据。