CT灌注成像对颈动脉狭窄支架置入后脑血流动力学的评价  

Evaluation of cerebral hemodynamics with CT perfusion imaging after carotid artery stenting

作　　者：蔡艺灵[1] 杜娟[1] 郑冬[2] 崔永强[1] 吴樵[1] 

机构地区：[1]解放军第三○六医院神经内科,北京100101 [2]解放军第三○六医院放射科,北京100101

出　　处：《中国脑血管病杂志》2011年第11期581-585,591,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的使用CT灌注成像(CTP)评价颈动脉支架置入术后脑血流灌注的变化。方法前瞻生纳入31例颈动脉中、重度狭窄患者,将其分为3组:无症状组,7例;脑梗死组,11例;TIA组,13例。均经DSA确诊单侧颈内动脉中、重度狭窄(无症状组一侧狭窄率>70%,另一侧狭窄率<30%,脑梗死、TIA组患侧狭窄率均>50%)。对全部患者行颈动脉支架置入术,共置入支架33枚。对所有患者均于术前及术后7d,行脑CTP检查。分别比较3组术前、术后7 d的相对脑血流量(rCBF),相对脑血容量(rCBV),相对平均通过时间(rMTT)及相对达峰时间(rTTP)。结果①同组术前、术后比较:无症状组术后rTTP(1.01±0.02)缩短,其余灌注指标变化不显著;TIA组的rTTP(1.10±0.06)、rMTT(1.06±0.04)较术前缩短,rCBF(0.96±0.02)增加;脑梗死组的rTTP(1.11±0.05)、rMTT(1.06±0.04)较术前缩短,rCBF(0.96±0.02)增加。均P<0.05;rCBV均无明显变化。②3组比较:术前3组rTTP、rMTT、rCBF的差异有统计学意义,均P<0.05;3组rCBV差异无统计学意义。术后3组rTTP比较,差异有统计学意义(P<0.05),3组rMTT、rCBF、rCBV差异无统计学意义。结论 CTP可以相对准确地反映颈动脉狭窄患者支架成形术前后的脑血流动力学状况.可成为头颈部动脉狭窄支架置入术后脑血流动力学改变的无创性评价方法。rTTP是评价早期缺血以及侧支循环代偿能力非常敏感的指标。Objective To evaluate the of cerebral blood perfusion changes after carotid artery stenting using CT perfusion imaging （CTP）. Methods Thirty-one patients with moderate or severe carotid stenosis were recruited prospectively. They were divided into 3 groups ： Asymptomatic group （ n = 7 ）, cerebral infarction group （n = 11 ） , and TIA group （n = 13）. They were all diagnosed as severe unilateral internal carotid artery stenosis （ 〉 70% stenosis on one side and 〈 30% stenosis on the other side in the asymptomatic group; ipsilateral stenosis 〉 50% in the cerebral infarction group and TIA groups）. All patients performed carotid artery stenting and a total of 33 stents were implanted. All patients performed CTP examination before stenting and within 7 days after stenting. The relative regional cerebral blood flow （rCBF） , relative regional cerebral blood volume （rCBV） , relative regional mean transit time （rMTT）, and relative regional time to peak （rTrP） before and after stenting in the 3 groups were compared. Results ①Comparison before and after stenting in the same group ： rTTP （ 1.01 ± 0.02） accelerated after surgery in the asymptomatic group, and the other perfusion indexes did not change significantly; rTTP （1.10 ±0.06） and rMTr （1.06 ±0.04） shortened compared to those before stenting, and rCBF （0.96 ± 0.02 ） increased in the TIA group ; rTTP （ 1.11 ± 0.05 ） and rMTT （ 1.06 ± 0.04 ） shortened than those before stenting, and rCBF （0. 96 ± 0.02） increased in the CI group （ all P 〈 0.05 ） ; there were no significant difference in rCBV. ②Comparison among the 3 groups： there were significant differences in rTTP,rMTT and rCBF before stenting among the 3 groups （ all P 〈 0.05 ） ; There were no significant differences in rCBV among the 3 groups. There were significant differences in rTTP among the 3 groups （ P 〈 0.05 ）. There were no significant differences in rMTT, rCBF, and rCBV among the 3 groups. Conclnsion CTP may

关 键 词：颈动脉狭窄 血管成形术 支架 体层摄影术 X线计算机 血流动力学 灌注 

分 类 号：R743[医药卫生—神经病学与精神病学]