CT脑灌注评估颈动脉狭窄的血流动力学改变  

Study of the Hemodynamic Changes of Carotid Artery Stenosis by CT Perfusion

作　　者：何文娟[1] 沈加林[1] 李飞平[1] 许建荣[1] 华小兰[1] 

机构地区：[1]上海交通大学医学院附属仁济医院放射科,上海200127

出　　处：《实用放射学杂志》2011年第3期334-337,397,共5页Journal of Practical Radiology

摘　　要：目的 评价CT脑灌注在评估颈动脉狭窄患者的脑血流动力学改变中的应用价值.方法 对50例临床诊断为可疑颈动脉狭窄的患者进行常规头颅CT平扫,CT灌注扫描（CT perfusion,CTP）及CT血管成像扫描（CT angiography,CTA）.CTP可获得脑血流量（CBF）,脑血容量（CBV）,平均通过时间（MTT）及达峰时间（TTP）等灌注参数图,CTA采用CPR,MPR及VR等重建方式重建头颈部血管.观察CTA所示的颈动脉狭窄率与CTP灌注参数变化间的关系.结果 38例单侧颈动脉狭窄患者中,10例轻度狭窄者,患侧各灌注参数变化与健侧各参数无统计学差异,9例中度狭窄与19例重度狭窄及闭塞患者中,患侧MTT与TTP较健侧显著延长,而CBF与CBV无明显变化.结论 灌注参数MTT与TTP能敏感地显示颈动脉中重度狭窄或闭塞患者的血流动力学改变,是诊断脑缺血最敏感的指标,为临床早期治疗提供可靠的依据,从而预防脑卒中的发生.Objective To evaluate the applied value of CT perfusion in hemodynamic changes of carotid artery stenosis. Methods 50 patients suspected to be carotid artery stenosis underwent unenhanced CT,CT perfusion（CTP） and CT angiography（CTA） . CTP images included cerebral blood flow （CBF） ,cerebral blood volume （CBV） ,mean transit time （MTT） and time to peak （TTP） perfusion parameters. CTA used CPR, MPR and VR to reconstruct carotid and cerebral arteries. The relationship between vascular lesions and changes of CT perfusion parameters were observed. Results In the thirty-eight patients with single carotid artery stenosis, 10 cases were mild stenosis,and the differences of each perfusion parameters in the affected side and contralateral side were not statisticaly significant in the 10 cases. 9 cases with moderate arterial stenosis and 19 cases with severe arterial stenosis or occlusion,MTT and TTP prolonged significantly in the affected side than in the contralateral side, but CBF and CBV were not different significantly in these 28 patients. Conclusion MTT and TTP were sensitive to the hemodynamic changes of patients with moderate to severe arterial stenosis or occlusion,and were the most sensitive diagnostic indicators of cerebral ischemic disease, and provided the clinicians with reliable basis to prevent the occurrence of stroke.

关 键 词：颈动脉 颈动脉狭窄 血流动力学 体层摄影术 X线计算机 

分 类 号：R543.4[医药卫生—心血管疾病] R814.42[医药卫生—内科学]