基于CT灌注成像的颅内外动脉旁路移植术在治疗缺血性脑血管病中的应用  

Extracranial-intracranial Arterial Bypass based on Cerebral CT Perfusion Imaging for Ischemic Cerebrovascular Disease

作　　者：段鸿洲[1] 李良[1] 邱建星[2] 张扬[1] 伊志强[1] 张家湧[1] 鲍圣德[1] 

机构地区：[1]北京大学第一医院神经外科,北京100034 [2]北京大学第一医院医学影像科,北京100034

出　　处：《中国微创外科杂志》2013年第2期110-115,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：教育部高等学校博士点基金(20110001120050)

摘　　要：目的探讨脑CT灌注成像在指导及评价颅内外动脉旁路移植术(颞浅动脉-大脑中动脉搭桥术)治疗缺血性脑血管病中的作用。方法 2008年1月～2011年12月,43例有临床缺血表现的单侧颈内动脉闭塞或大脑中动脉闭塞或大脑中动脉高度狭窄,术前进行脑血管造影及脑CT灌注成像,选取感兴趣区(region of interest,ROI),测量并评估多个ROI区域以下指标的平均值:相对脑血流量(relative cerebral blood flow,rCBF)、脑血容量(relative cerebral blood volume,rCBV)、平均通过时间(relative mean transmit time,rMTT)及达峰值时间(relative time to peak,rTTP),结合患者临床表现及脑血流评估结果,选取有手术适应证的患者进行颞浅动脉-大脑中动脉搭桥手术。手术后复查脑血管造影及脑CT灌注成像,测量术后rCBF、rCBV、rMTT、rTTP。术后对患者进行长期随访并应用美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)对患者手术前后神经功能状态进行评估。结果①43例均顺利进行颞浅动脉-大脑中动脉搭桥术,术后造影42例(97.7%)吻合口通畅,术后NIHSS评分均较术前明显降低(术前3.67±1.02,术后1周3.30±0.89,术后3个月2.88±0.96,术后12个月2.34±1.02,与术前相比,t=2.634,P=0.012,t=5.373,P=0.000,t=7.342,P=0.000),随访期间未再出现与患侧相关的脑卒中。②43例手术前后脑CT灌注成像结果显示,术前患侧rCBF较健侧明显降低[(31.37±9.29)ml.100g-1.min-1 vs.(45.41±6.91)ml.100g-1.min-1,t=-7.921,P=0.000],rMTT、rTTP较健侧明显升高[rMTT(11.32±3.19)s vs.(8.43±1.95)s,t=5.754,P=0.000;rTTP(3.71±1.22)s vs.(2.03±0.87)s,t=9.889,P=0.000],rCBV与健侧差异无显著性(P>0.05)。术后1周患侧rCBF较术前明显升高[术后(44.05±10.24)ml.100g-1.min-1,t=-7.273,P=0.000],rCBV与术前差异无显著性(P>0.05),rMTT、rTTP较术前明显降低[rMTT术后(8.16±1.99)s,t=7.743,P=0.000;rTTP术后(1.88±1.29)s,t=7.333,P=0.000]。手术后患侧以上指标与健侧Objective To evaluate cerebral CT perfusion imaging in guiding and assessing extracranial-intracranial （EC-IC） arterial bypass （STA-MCA bypass） for ischemic cerebrovascular diseases. Methods Forty-three patients with atherosclerotic carotid artery occlusion, middle cerebral artery occlusion or severe stenosis were enrolled into this study. DSA and cerebral CT perfusion scan were carried out preoperatively, and regions of interest （ROI） were selected to measure and assess relative cerebral blood flow （rCBF） , relative cerebral blood volume （rCBV）, relative mean transient time （rMTT） , and relative time to peak （rTTP）. Based on the parameters and clinical features, patients with indications received STA-MCA bypass accordingly. DSA and cerebral CT perfusion scan were repeated after the procedure to determine postoperative rCBF, rCBV, rMTT, and rTTP. All the patients were followed up and their neurological deficit before and after the operation were evaluated with the National Institute of Health Stroke Scale （NIHSS）. Results STA-MCA bypass was completed successfully in all the patients, postoperative angiography showed that the anastomotic orifice in 42 of the patients （97.7%） were patent, and their NIHSS scale decreased after the operation （1 week, 3 months and 12 months vs. preoperation： 3.30±0.89, 2.88±0.96 and 2.34±1.02 vs. 3.67±1.02; t=2.634, P=0.012, t =5.373, P =0. 000, and t = 7. 342, P = 0. 000, respectively）. No relative ipsilateral stroke occurred during follow-up. Preoperative CT perfusion showed that the symptomatic hemisphere had significantly lower rCBF than the normal hemisphere （31.37 ± 9.29 ） ml· 100 g^-1·min^-1 vs. （45.41±6.91） ml·100g^-1·min^-1, t= -7.921, P=0.000], but higher rMTT and rTTP （11.32 ±3. 19） s vs. （8.43 ±1.95） s, t=5.754, P=0.000 and （3.71±1.22） s vs. （2.03 ±0.87） s, t=9.889, P=0.000, respectively]. No significant difference was detected in rCBV between the two hemispheres （P 〉 0.05）. Postoperativ

关 键 词：颅内外动脉旁路移植术 脑血管障碍 脑CT灌注成像 

分 类 号：R651.1[医药卫生—外科学]