CT灌注成像评估脑出血患者血流动力学的变化  

CT perfusion imaging evaluation on hemodynamics of patients with intracerebral hemorrhage

作　　者：孙祥荣[1] 郭富强[1] 陶克言[2] 韦永胜[1] 余能伟[1] 李晓佳[1] 黄雨兰[1] 董凌琳[1] 汪瑾宇[1] 

机构地区：[1]四川省人民医院神经内科,成都610072 [2]四川省人民医院CT室,成都610072

出　　处：《中国脑血管病杂志》2008年第2期54-58,共5页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的采用CT灌注成像(CT perfusion,CTP)研究脑出血患者血流动力学的变化。方法选择经CT确诊的幕上脑出血患者41例,于发病5h^14d行双层脑CTP检查,按发病到检查时间将患者分为≤12h,>12~24h,>24~48h,>48~72h,>72h^2周。采用非去卷积模型斜率法计算血肿中心、血肿周围水肿带、水肿带外(距离水肿边缘1cm)以及远隔皮质区不同感兴趣区的脑血流量(cerebral bolood flow,CBF)、相对脑血容量(relative cerebral blood volume,rCBV)、达峰值时间(peak time,PT)及各感兴趣区时间密度曲线(time density curve,TDC)。以CBF≤20ml.100g-1.min-1为脑灌注损伤。结果所有患者灌注参数图从血肿中心到正常区色差呈阶梯状分布;血肿中心、血肿周围水肿带、水肿带外及远隔皮质区的平均CBF[(2.5±1.9)、(19.8±10.1)、(42.2±9.2)、(54.8±8.8)ml.100g-1.min-1]、rCBV[(2.9±1.7)、(7.1±4.3)、(25.8±5.1)、(37.9±4.5)%]及PT[血肿中心无峰值,(9.0±1.7),(8.0±1.1),(8.0±1.3)s]组内比较,差异均有统计学意义(P=0.000,P=0.000,P=0.015)。②CTP灌注参数图所示的灌注损伤为(11±5)cm2,CT平扫显示的平均血肿范围为(6±3)cm2,两者比较差异有统计学意义(t=-10.99,P=0.000)。③血肿≥10ml的患者26例,15例CBF≤20ml.100g-1.min-1;血肿<10ml的患者14例,2例CBF≤20ml.100g-1.min-1。水肿带CBF与血肿体积呈直线相关(r=-0.501,P=0.001)。④血肿周围以上各区的CBF在不同时间段差异均无显著性,P>0.05。⑤脑积水患者的CBF和rCBV明显降低,而PT明显延长。结论CTP能够很好地反映脑出血后脑组织的血流动力学变化;血肿周边存在与血肿大小有关的缺血性损伤。Objective To investigate hemodynamic changes in patients with intracerebral hemorrhage （ICH） using computed tomography perfusion （CTP） imaging. Methods Forty-one patients with supratentorial ICH diagnosed by CT were selected. Two layers of CTP was performed from 5 hours to 2 weeks after the onset of ICH. The patients were divided into ≤12 h, 12 to 24 h, 24 to 48 h, 48 to 72 h, 72 h to 2 weeks groups according to the time from the onset of symptom to initial examination. The cerebral blood flow （ CBF）, relative cerebral blood volume （ rCBV ）, peak time （PT） and time density curve （TDC） in the center of hematoma, the edema zone around the hematoma （ 1 cm from the edema edge）, outside edema zone and the different regions of interest （ROI） in remote cortical areas were calculated with the non-deconvolution model （slope method）. Cerebral perfusion injury was defined as CBF≤20ml·100g^-1·min^-1.Results The aberration from the center of hematoma to the normal area in all the perfusion parameter maps of the patients showed a ladder-like distribution; the average CBF of the center of hematoma, edema zone around the hematoma, outside edema zone, and remote cortical area were 2. 5 ± 1.9, 19. 8 ± 10. 1, 42.2 ±9.2, and 54. 8 ±8. 8 ml·100g^-1·min^-1 ; their average rCBV were 2.9 ± 1.7, 7.1 ±4. 3, 25.8 ±5.1, and 37.9 ±4. 5% ; and their average PT were 9. 0 ± 1.7, 8.0 ± 1.1, and 8.0 ± 1.3 s, respectively. There were statistical differences among these groups （ P = 0. 000, P = 0. 000, and P = 0. 015 ）. Perfusion injury showed by CTP perfusion parameter maps was 11 ± 5 cm^2 , the average size of hematoma showed by plain CT scan was 6 ± 3 cm^2, and there was statistical difference between them （t = - 10. 99,P=0. 000）. The hematoma ≥10 ml in 26 patients, CBF 〈 20 ml·100g^-1·min^-1 in 15 patients; the hematoma 〈 10 ml in 14 patients, and CBF 〈20 ml·100g^-1·min^-1 in 2 patients. The CBF in edema zone was positively linearly correlated with the hematoma volume

关 键 词：脑出血 脑缺血 CT灌注成像 血液动力学过程 

分 类 号：R743.3[医药卫生—神经病学与精神病学]