脑动脉瘤破裂手术前后的脑灌注成像探讨  

The study of cerebral perfusion imaging for the ruptured cerebral aneurysms before and after the operation

作　　者：林怡[1] 段玉霞[1] 李瑞[1] 陈伟建[1] 吴楠[1] 童秋云[1] 王殊[1] 

机构地区：[1]温州医科大学附属第一医院放射影像中心,浙江温州325000

出　　处：《温州医学院学报》2013年第7期456-460,共5页Journal of Wenzhou Medical College

基　　金：浙江省公益性技术应用研究计划项目(2011C23021)

摘　　要：目的:通过CT灌注成像观察颅内动脉瘤破裂出血手术前后的脑血流变化,为临床后续治疗提供相关信息。方法:回顾性分析颅内动脉瘤破裂手术前、后临床资料44例。所选患者术前行CT血管成像(CTA)和CT灌注成像(CTP)检查,并于术后1周行CTP复查。分别测量前后两次CTP的大脑前动脉区(ACA区)、大脑中动脉区(MCA区)、大脑后动脉区(PCA区)及基底节区灌注值。结果:44例入选患者中,34例伪彩图肉眼可见好转,患者的ACA区、MCA区、PCA区及基底节区脑血流量(CBF)与平均通过时间(MTT)变化差异有统计学意义(P<0.05);8例肉眼可见局部灌注减低区的MTT值均延长、CBF值减低;2例灌注值未见明显异常。所有患者的脑血容量(CBV)值变化差异均无统计学意义。结论:颅内动脉瘤破裂手术前及手术后存在脑灌注调整,视个体和病情各异,脑灌注也将发生相应的变化。Objective： To provide relevant information for clinical follow-up treatment through the observation on cerebral hemodynamic changes of ruptured intracranial aneurysm before and after operation in the CT perfusion imaging. Methods： The retrospective analysis of the pre-and post-operative clinical data in 44 patients with ruptured cerebral aneurysms was performed. These patients underwent CTA and CTP examination simultaneously before surgery, followed by CTP examination after operation. Then the perfusion values of anterior cerebral arterial territory （ACA area）, middle cerebral arterial territory （MCA area）, posterior cerebral arterial territory （PCA area） and basal ganglia area were respectively measured. Results： Among the 44 patients, the pseudo-color images of 34 patients showed visible improvement. In these patients, there was a significant change （P〈0.05） between CBF and MTT in ACA, MCA, PCA and basal ganglia area. In the decreased perfusion area of 8 patients, which was visible to the naked eye, the MTT value was extended, and the CBF value was decreased. However, no obvious abnormal value of perfusion was detected in the other 2 patients. There was no statistical significance in CBV among all the patients. Conclusion： Our findings indicate that there is an adjustment in cerebral perfusion of the ruptured intracranial aneurysms before and after operation.A change in the individual condition can bring a corresponding change in the cerebral perfusion.

关 键 词：动脉瘤 蛛网膜下腔出血 CT灌注 血管痉挛 颅内 体层摄影术 X线计算机 

分 类 号：R733.2[医药卫生—肿瘤]