高血压脑血肿周围组织的CT灌注成像研究  

Study of perihematomal perfusion in patients with intracerebral hemorrhage with dynamic CT perfusion imaging

作　　者：马春[1] 余聪[1] 赵建农[1] 郭大静[1] 李杰[1] 罗银灯[1] 谢微波[1] 沈霞[1] 

机构地区：[1]重庆医科大学附属第二医院放射科,重庆400010

出　　处：《中国医学影像技术》2008年第5期641-644,共4页Chinese Journal of Medical Imaging Technology

基　　金：重庆市卫生局医学科学技术研究项目(06-2-073)资助

摘　　要：目的应用动态CT灌注成像对急性期及亚急性期高血压脑血肿周围组织灌注情况进行观察,并探讨其转归。方法对15例采用内科保守治疗的高血压脑出血病人进行前瞻性研究,分别于急性期及亚急性期行CT平扫及CT灌注成像扫描。测量血肿周围组织及对侧镜像区脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)及急性期血肿最大层面血肿及周围低灌注区面积,于亚急性期选择与急性期同一层面测量血肿周围强化环所包围的面积。结果灌注参数图示急性期血肿周围组织CBF、CBV均较对侧镜像区降低(Z分别为3.124、3.239,P值均小于0.05),MTT较对侧延长(Z=2.726,P<0.05)。亚急性期血肿周围组织CBF亦较对侧降低(Z=3.408,P<0.05),与急性期比较无明显变化(Z=1.136,P>0.05);血肿周围组织CBV也降低(Z=2.159,P<0.05),但是与急性期比较有较明显升高(Z=1.988,P<0.05);MTT较对侧延长(Z=3.351,P<0.05),与急性期比较无明显差异(Z=1.193,P>0.05)。急性期血肿最大层面血肿及周围组织之低灌注区面积与亚急性期同一层面血肿周围强化环所包围之面积比较无明显差异(Z=1.590,P>0.05)。结论高血压脑出血病人血肿周围于急性期存在低灌注状态,而经保守治疗后这种低灌注状态在亚急性期并不会有明显改善,且处于低灌注状态的组织最终很可能会坏死。Objective To＇observe perihematomal perfusion in acute and subacute intracerebral hemorrhage （ICH） in patients with hypertension with dynamic CT perfusion imaging （CTPI）, and analyse prognoses of perihematomal tissue. Methods Fifteen cases with ICH were enrolled into this prospective study, non contrast CT and dynamic CT perfusion imaging were performed respectively in acute and subacute ICH. Cerebral blood flow （CBF）, cerebral blood volume （CBV） and mean transit time （MTT） of ipsilateral perihematoma and contralateral mirroring areas were obtained. Hypoperfusion area of he matoma and perihematoma zone in the largest axial section of hematoma were measured,and so was area surrounded by perihematomal enhancement rim in identical section with acute hematoma in subacute hematoma. Results There were significantly decreased CBF and CBV and prolonged MTT in the acute perihematomal zone against contralateral hemisphere （Z= 3. 124, 3. 239, 2. 726, respectively, P〈0. 057. Decreased CBF in suhacute perihematomal areas （against contralateral hemisphere, Z =3. 408, P〈0. 05）showed no significant difference with that in acute phase （Z= 1.13S, P〉0. 05）. Decreased CBV in subacute perihematomal areas （Z= 2. 159, P〈0.05） increased significantly compared with that in acute perihematomal areas （Z= 1. 988, P〈0. 05）. MTT prolonged than contralateral hemispere （Z= 3.351, P〈0. 05）repesented no significant difference with that in acute phase （Z= 1. 193, P〉0. 057. Area of hypoperfusion in hematoma and perihematoma zone in the largest axial section of hematoma showed no significant difference with area surrounded by perihematomal enhancement rim in identical section with acute hematoma measured in subacute hematoma （Z= 1. 590, P〉0. 05）. Conclusion CTPI can demonstrate perihematomal hypoperfusion in patients with acute ICH. However, this condition couldn＇t be relieved remarkably after conservative treatment, and tissue under hypoperfusion might have outcome of necrosis at la

关 键 词：脑出血 高血压 灌注 体层摄影术 X线计算机 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R814.42[医药卫生—临床医学]