Ultrasonography Study of Extracranial Vertebral Artery and the Relationship with Cell Apoptosis in Brain Stem
|School||China Medical University|
|Course||Medical Imaging and Nuclear Medicine|
|Keywords||Pediatric Extracranial Vertebral artery Congenital Abnormal Rabbit Color Doppler flow imaging Ultrasound Posterior circulation Ischemia Apoptosis Apoptotic index Correlation|
Introduction vertebrobasilar system, also known as the posterior circulation. Major supplier of the blood supply of the brain stem and cerebellum, posterior circulation ischemia is common ischemic cerebrovascular disease, accounting for about 20% of ischemic stroke. Clinical manifestations of posterior circulation ischemia caused limb weakness, dizziness, ataxia, headache, syncope and other symptoms. The etiology is more common in the vertebral artery stenosis or occlusion due to hemodynamic hypoperfusion. The nervous system is very sensitive to ischemia, nerve cell death after ischemia is not necrotic, but apoptosis. Tracts in the meantime through due to the brainstem is important neural activity site, cranial nerve, the ascending reticular activating system, and up and down, medulla oblongata, pons, and part of the cranial nerve dysfunction can be caused when the blood supply, will emergence of a variety of different, but overlapping clinical manifestations. Apoptotic or anti-apoptotic diversity, coupled, multi-channel signal transduction process. The most convincing evidence of neurons after cerebral ischemia apoptosis research on the molecular mechanisms in recent years due to the discovery and study of the mechanism of apoptosis, a growing number of experiments prove that the diseases of the nervous system, such as there is a close relationship between epilepsy, Parkinson's disease, Alzheimer's disease, cerebral ischemia and apoptosis. This study normal and abnormal blood flow parameters of the vertebral artery in children; then establish rabbit posterior circulation ischemia model, experimental study simulated clinical change, using color Doppler ultrasound technology get rabbits vertebral artery blood flow, blood flow velocity and other blood hemodynamic parameters, a comparative study, evaluate whether the posterior circulation insufficiency; staining test rabbit brain tissue, circulating blood supply to the the regional nerve cell morphology change observed, calculated brainstem neuronal apoptosis index, ultrasonic testing blood flow parameters and apoptotic index correlation analysis between the exact theoretical and experimental basis for the accurate diagnosis of the disease. Materials and methods 1,2007 December - December 2008, 156 patients in our hospital neurology clinic, the main reference headache, dizziness, syncope, head symptoms, the use of American GE LOGIC 7 color Doppler ultrasound diagnostic apparatus, the probe frequency is 10MHz, line ultrasound detected 42 cases of congenital vertebral artery abnormal cases, 12 cases of vertebral artery asymmetry, 15 cases of intervertebral foramen at the distortions of the vertebral artery, 5 cases of bilateral vertebral artery development of asymmetry associated with the distortion of the vertebral artery, 6 cases of congenital vertebral artery developmental adverse, four cases were the origin of the vertebral artery, and running an exception. Elect 86 cases 2-14 years old normal children as a control group, the control group, blood vessel diameter and hemodynamic parameters were statistically significant differences (p gt; 0.05). The group of children of all cases the EEG, the results were negative. Ultrasound in children vertebral artery sonographic data, including vertebral artery diameter, course, beat, spectral shape, and blood flow. February -2010 January 2,2009, select 61 Japanese white rabbits as research subjects. Japanese Aloka α10 color Doppler ultrasonic diagnostic apparatus, the probe frequency 10MHz. Rabbit anesthesia record bilateral vertebral artery-dimensional ultrasound and color Doppler ultrasound sonographic characteristics to establish the rabbit vertebral artery ligation and narrow model, the vertebral artery ligation group, vertebral artery stenosis group, compare the differences between each set of parameters, After two hours, one day, two days at different times test rabbit ultrasound examination, the pathological basis of the two-dimensional and color Doppler hemodynamic parameters, to investigate the clinical change. 3, the rabbits were killed, taking the total length of the brainstem organization of the basilar artery, HE staining, observed changes in cell morphology after ischemia, and brain stem detection of apoptotic cells, calculated apoptotic index, apoptotic index of different groups of statistical analysis; analysis of vertebral artery case group blood flow parameters and the brainstem apoptosis index correlation. 1,156 children detected 42 cases of congenital vertebral artery abnormal cases, 12 cases of vertebral artery vertebral artery asymmetry group foraminal the twisted group at 15 cases, bilateral vertebral artery asymmetry associated with vertebral artery twisted group 5 cases of congenital vertebral artery dysplasia group six cases, children with the origin of the vertebral artery and go to line 4 cases of abnormal group, composed of five case group. Bilateral internal diameter, PSV, blood flow (volume) differences between children with normal control group compared with five cases of group between p lt; 0.05; between the affected and the control group in the case group EDV, RI there are differences, p lt; 0.05. Vertebral artery asymmetry group of 12 patients, bilateral vertebral artery diameter difference of 1mm or more, including four cases left and right side of the eight cases, bilateral vertebral artery diameter, volume and normal control group comparison p lt; 0.05, contralateral EDV comparison with the normal control group a significant difference, p lt; 0.05, ipsilateral PI, RI and normal control group was significantly different, p lt; 0.05. Intervertebral foramen at the vertebral artery the twisted group 15 cases occurred in the bilateral five cases, five cases of left and right side in five cases, the contralateral vertebral artery PSV, EDV, volume and normal control group comparison, p lt; 0.05. Bilateral vertebral artery asymmetry associated with vertebral artery distorted group of five cases, the distortions have occurred on the right side, the asymmetric right side of the three cases, two cases left, fine ipsilateral internal diameter, compared with the normal control group p lt; 0.05 contralateral blood flow, compared with the normal control group p lt; 0.05. Six cases of congenital vertebral artery dysplasia group, the inner diameter of less than 2mm wall thickening, poor blood flow filling pulse weakened, occurred in 5 cases, the left and right 1 the the ipsilateral inner diameter, PSV, EDV, volume and compared to the control group reduced significantly decreased, p lt; 0.05. Children with the origin of the vertebral artery and traveling abnormal group 4 cases, the proximal vertebral artery originated directly from the aortic arch in 1 case, 2 cases of vertebral artery across the 6,5 foraminal 4 foraminal uplink cases beyond the first after 6 intervertebral foramen into 5 foraminal uplink, ipsilateral and normal control group inside diameter, PSV statistically significant, the inner diameter is less than the normal control group, PSV is higher than the normal control group, p lt; 0.05. The contralateral internal diameter, EDV, PI, RI and control group was statistically significant contralateral vertebral artery diameter widened EDV speed faster, the resistance decreases, to compensatory increase vertebrobasilar arterial. Construct rabbit circulation ischemia model, a control group, 2 groups for 100% of the vertebral artery ligation group, the three groups of the vertebral artery, 70% -100% stenosis group. Were two hours, one day, two days, three days, four days, five days, six days rabbits anesthesia vertebral artery ultrasound, hemodynamic parameters. The comparison between the normal control group and the two case groups among the three groups PSV, EDV, volume, and PI, RI was statistically significant, p lt; 0.05. Ligation group and normal control group contralateral blood flow faster, blood flow, p lt; 0.05, group comparison at different times after PSV, EDV upward trend, p lt; 0.05. Narrow group and normal control group, the contralateral PSV, EDV, volume increased significantly, PI, RI decreased significantly, there are statistically significant, p lt; 0.05, compared to the ipsilateral PSV, PI, RI, volume and normal control group decreased significantly, there was also significant, p lt; 0.05, group comparison after different time hemodynamic parameters was not statistically significant, p gt; 0.05, to take rabbits basilar artery total length of the brainstem, 10 % neutral buffered formalin fixed for more than four hours, embedded in paraffin, in the middle of each of the basilar artery drawn, each point of a slice thickness 3μm. HE staining microscope the vertebral artery different degree of stenosis of its blood supply to the area of ??structural changes in the morphological changes of the neurons as the determination of indicators of ischemia. The microscopic observation of apoptotic cells, calculated the apoptotic index. 4, the apoptotic index between the normal control group and the case group using one-way ANOVA revealed no statistically significant, p gt; 0.05. The apoptotic index Statistical analysis shows vertebral artery ligation group group drawn at different times, with animal models, apoptosis index upward trend, and narrow groups with different sampling time and between brainstem apoptosis index no correlation, p gt; 0.05 , was not statistically significant. Pearson correlation analysis showed a positive correlation between the case group of rabbits ultrasound blood flow parameters and brainstem apoptotic index, apoptotic index model survival time, PSV, volume was positively correlated with p lt; 0.05. Conclusion 1, ultrasound can accurately display of pediatric extracranial segment abnormalities vertebral artery morphology and running. 2 dimensional ultrasound morphological changes with a high clinical value in the evaluation of congenital pediatric vertebral artery abnormalities combined hemodynamic parameters and blood supply of the posterior circulation. 3, through the establishment of an animal model to study circulation ischemia, very close to the clinical vertebrobasilar obstacles, in theory and in clinical practice of Medicine has a certain significance. Case group of rabbits apoptotic index hemodynamic parameters, on the one hand, the vertebral artery stenosis and occlusion with brainstem cell apoptosis, confirmed the close correlation between ischemic time and apoptosis the other hand, compensatory gradually extended survival time machine experience by improving blood flow velocity increased circulation of blood flow to maintain the body's normal survival status.