头颅CT灌注成像在球囊闭塞试验中的辅助作用  

Clinical application of CT perfusion in balloon occlusion test

作　　者：廖煜君[1] 徐斌[1] 宋冬雷[1] 冷冰[1] 

机构地区：[1]复旦大学附属华山医院神经外科,上海200040

出　　处：《中华神经外科疾病研究杂志》2010年第6期492-495,共4页Chinese Journal of Neurosurgical Disease Research

基　　金：国家自然科学基金资助项目(304717E9);上海市科委重点科技攻关资助项目(07419504)

摘　　要：目的探讨头颅CT灌注成像(CTP)在球囊闭塞试验(BOT)中的辅助判断作用。方法 20例经DSA确诊的颈内动脉巨大动脉瘤患者,临床判断为BOT阴性的同时行头颅CTP,通过比较双侧半球的脑血流量(CBF)、脑血容量(CBV)及达峰时间(TTP)对脑血流动力学进行评估。结果 20例患者均在BOT过程中完成CTP且无任何脑缺血症状,17例(85.0%)灌注对称,判断为耐受性良好,16例行永久性颈内动脉球囊闭塞术(其中4例联合动脉瘤部分栓塞术),1例行颈内动脉慢性阻断术;3例(15.0%)灌注不对称,主要为阻断侧TTP延长,CBV正常或轻度升高,而CBF基本正常,即存在早期的脑血流动力学损害,认为其无法耐受颈内动脉的永久闭塞,其中2例行颅内外动脉搭桥联合动脉瘤孤立术,1例行支架辅助的动脉瘤致密栓塞术,载瘤动脉保留完整。所有患者随访15～32个月,均无远期缺血并发症。结论 CTP能检出BOT阴性者潜在的脑血流动力学损害,可以更客观地评估其对颈内动脉永久闭塞的耐受力,是BOT的重要补充。Objective To explore the supplementary effect of CT perfusion （CTP） on the balloon occlusion test （BOT）.Methods A total of 20 patients with giant internal carotid artery （ICA） aneurysms diagnosed by DSA were performed CTP during BOT. Cerebral blood flow （CBF）, cerebral blood volume （CBV） and time to peak （TTP） maps were used to evaluate the cerebral hemodynamics.Results CTP showed no ischemia changes in all the patients. Seventeen patients（85.0%）showed symmetric perfusion and were regarded to have good endurance, in which 16 patients underwent permanent ICA occlusion （4 patients underwent partial occlusion of aneurysm at the same time） and 1 patient underwent chronic ICA occlusion. The other 3 cases（15.0%） showed asymmetric perfusion and early ischemic damage in various degrees, mainly characterized by prolonged TTP, with normal or slightly abnormal CBV and normal CBF, which meant permanent ICA occlusion couldn＇t be used. Extra-cranial to intra-cranial （EC-IC） bypass was successfully performed before ligation of ICA in 2 of 3 patients, and the last one received stent-assisted aneurysm embolization with the patency of parent artery. No ischemia complication was detected in all of 20 patients during 15~32 months＇ follow-up.Conclusion As an effective method in evaluating cerebral hemodynamics, CTP is useful in predicting potential patients for stroke after permanent occlusion.

关 键 词：CT灌注成像 球囊闭塞试验 巨大动脉瘤 

分 类 号：R651[医药卫生—外科学]