CT灌注表面通透性对预测急性缺血性脑卒中后出血性转化的意义  

Prediction of hemorrhagic transformation in acute ischemic stroke using permeability surface of CT perfusion

作　　者：熊兵[1] 陈伟建[2] 付凤丽[3] 段玉霞[2] 杨博洋[2] 王宏清[2] 杨运俊[2] 梁盼[2] 林怡[2] 王殊[2] 吴楠[2] 童秋云[2] 

机构地区：[1]浙江大学医学院附属第一医院放射科,310003 [2]温州医学院附属第一医院放射科,325000 [3]浙江医院放射科

出　　处：《中华放射学杂志》2012年第7期593-597,共5页Chinese Journal of Radiology

基　　金：国家科技部“十二五”科技支撑计划重点资助项目（2011BAl08BOO）;温州科技对外合作资助项目（H20090009）;浙江省科技计划资助项目（2011C23021）

摘　　要：目的探讨CT灌注表面通透性（PS）在预测急性缺血性脑卒中（AIS）后出血性转化（HT）中的价值。方法发病3-9h内的AIS患者31例，全部行头颅CT平扫和灌注（CTP）检查，根据复查cT平扫图像判断患者有无发生HT，将入选患者分为出血组（11例）及未出血组（20例），测量患者患侧和健侧PS、脑血流量（CBF）、脑血容量（CBV）及平均通过时间（MTT）值，并计算其比值，得到相对表面通透性（rPS）、相对脑血流量（rCBF）、相对脑血容量（rCBV）及相对平均通过时间（rMTT）值。采用Wilcoxon秩和检验比较分析出血组及未出血组rPS之间的差异，采用独立样本t检验比较两组rCBF、rCBV、rMTF及两组患侧Ps值的差异，采用Spearman秩相关分析各灌注参数与HT间的相关性。结果出血组和未出血组患侧Ps值分别为（1．61±0．77）、（0．91±0．49）ml·min^-1·100g^-1；出血组rPS、rCBF、rCBV、rMTY值分别为2．76±0．78、0．32±0．18、0．66±0．31、2．67±0．71，未出血组对应数值分别为1．354-0．19、0．50±0．21、0．91±0．28、2．62±1．31，与未出血组患者相比，出血组患者的rPS值及PS值较高，差异有统计学意义（U=0．000，t=3．070；P值均〈0．01）；出血组rCBF、rCBV值较未出血组减低，差异有统计学意义（t值分别为2．343、2．210；P值均〈0．05）；两组rMT？值差异无统计学意义（t=0．118，P〉0．05）。PS及rPS值均与HT呈正相关（相关系数r值分别为0．496、0．821，P值均〈0．01），其中rPS与HT相关性较高。结论CT灌注rPS值在预测AIS后HT中有重要意义，有利于指导临床个性化治疗方案的制定，降低患者不良反应的发生。Objective To investigate the value of permeability surface （PS） in predicting hemorrhagic transformation （HT） in acute ischemic stroke （ AIS ） using CT perfusion （CTP）. Methods The study included 31 consecutive patients who presented symptoms suggestive of an AIS for 3-9 h. All patients underwent CT examination （noncontrast CT, CTP）. HT was determined by follow-up CT images. According to presence of HT, the AIS was divided into HT group （PSHT,11 patients） and non-HT group （PSNo.HT ,20 patients）. PS, cerebral blood flow （CBF）, cerebral blood volume （CBV） and mean transit time （MTT） on both sides of brains were measured. The relative PS（ rPS）, relative CBF （rCBF）, relative CBV（rCBV） and relative MTT（rMTT） were obtained by calculating the ratio of the values of bilateral regions. The rPS between PSHT and PSNo_HT was compared with an exact Wilcoxon signed-rank test. The rCBF, rCBV, rMTI＂ and the PS of the isehemic side between PSHT and PSNo_HT were compared with independent-sample t test. Meanwhile, Spearman rank correlation analysis was conducted to analyze therelationship between the CTP parameters and HT. Results The PS value of ischemic side was （ 1.61±0.77） ml ·min-1·100 g-l for the PSHT group, and the value was （0. 91±0.49） ml·min-1·100 g-1 for the PSNo.HT group. For the PSHT group, rPS, rCBF, rCBV, rMTI＂ were 2. 76±0. 78,0. 32±0. 18,0. 66±0. 31,2. 67±0. 71 ,and for the PSNo-HT group, rPS, rCBF, rCBV, rMTT were 1.35±0. 19,0. 50±0. 21, 0.91±0. 28,2. 62±1.31. Compared with PSNo_HT, PSHT had higher rPS and PS value, and there were significant statistical differences （ U = 0. 000, t = 3. 070, P 〈 0. 01 ）. But rCBF and rCBV values were lower in the PSHT group compared to the PS o.HT group, and there were significant statistical differences （trCBF = 2. 343, trCBV = 2. 210, P 〈 0. 05 ）. There was no significant statistical difference in rMTT between the two groups（t =0. 118 ,P 〉 0. 05 ）. Significant positive correlation

关 键 词：脑血管意外 毛细血管通透性 体层摄影术 X线计算机 

分 类 号：R743.3[医药卫生—神经病学与精神病学]