基线CT灌注预测动脉瘤性蛛网膜下腔出血患者延迟性缺血的研究  

CT perfusion deficit during the early baseline period in aneurysmal subarachnoid hemorrhage is predictive of development of delayed cerebral ischemia

作　　者：吴楠[1] 陈伟建[1] 王殊[1] 童秋云[1] 林怡[1] 张辉[1] 郭翔[1] 

机构地区：[1]温州医学院附属第一医院放射科,浙江省325000

出　　处：《中华脑科疾病与康复杂志（电子版）》2013年第2期8-12,共5页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

基　　金："十二五"国家科技部科技支撑计划项目(2011BAI08B09);浙江省公益性技术应用研究计划项目(2011C23021);温州科技对外合作项目(H20090005)

摘　　要：目的探讨基线CT灌注（computed tomography perfusion，CTP）对动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrage，SAH）延迟性缺血（delay cerebral ischemia，DCI）的预测作用。方法回顾性分析2011年8月至2012年9月54例动脉瘤性SAH患者基线和1周后CTP。计算优势出血侧与对侧各参数比值，即相对血容量（rCBV）、相对血流量（rCBF）、相对平均通过时间（rMTF），感兴趣区（ROI）选基底节为中心的两层大脑前动脉分布区（ACA区）、中动脉分布区（MCA区）、后动脉分布区（PCA区）、基底节区及前、后分水岭区。结合复查CTP、CT平扫及神经功能临床评估确定DCI组和无DCI组，对两组基线、复查CTP分别行两样本t检验；对DCI组两次CTP行配对t检验；基线rCBF分为≤0．75、0．75〈rCBF〈0．85、≥0．85组，用，检验分析组间DCI发生率差异，运用SPSS16．0软件，P〈0．05为有统计学差异。运用MedCalc9．62．0通过受试者工作特征曲线（ROC）确定预测DCI的理想基线rCBF、rMTT、rCBV值。结果18例（18／54，33．3％）发生DCI，基线CTP比较，DCI组、无DCI组平均rCBF分别为0．78和1．01（t=6．63，P〈0．01），rCBV分别为0．90和1．01（t=4．43，P〈0．01），rMTT分别为1．24和0．96（t=5．29，P〈0．01）。DCI组复查较基线rCBF减低（t=3．18，P〈0．05）、rCBV减低（t=2．83，P〈0．05）、rMTT无统计学差异（t=0．99，P=0．38）。不同基线rCBF水平DCI发生率有统计学差异（，=38．00，P〈0．05）。ROC分析：理想基线rCBF为0．84，预测DCI的敏感性、特异性分别87．5％、90．62％，曲线下面积（AUC）为0．945（95％CI：0．824～0．992）；rMTF为1．1，敏感性、特异性分别为75，00％、84．37％，AUC为0．844（95％CI：0．694～0．939）；rCBV为0．94，敏感性、特异性分别为75．00％、71．87％，AUC为0．781（95％CI：0．622～0．896）。结论在基线期采Objective To assess the diagnostic accuracy of CT perfusion （CTP）during admission baseline period defined as days 0-3 following aneurysmal subarachnoid hemorrhage （ A-SAH ） for the prediction of development of delayed cerebral ischemia（DCI）. Methods CTP image data of baseline and 1 week after onset about 54 A-SAH patients from Aug 2011 to Sep 2012 were retrospectively studied. Relative cerebral blood volume（rCBV） ,relative cerebral blood flow（rCBF） and relative mean transit time（rMTT） were measured. ROI was performed in anterior cerebral artery area （ACA area ）, middle cerebral artery area （MCA area）,basal ganglia area,posterior cerebral artery area（ PCA area）,front and back watershed area. Patients were divided into DCI and no DCI groups by combination of non-contrast CT, CTP reexamination and clinical assessment of neurological deficits. Quantitative baseline and reexamination PCT data for all patients were evaluated for statistically significant differences between DCI and no DCI groups utilizing Student＇s t test. Compare the quantitative baseline and PCT reexamination data of DCI with paired Student＇ s t test. Baseline rCBF was divided into three groups as rCBF≤0. 75 ,ranged from 0. 75 to 0. 85 and rCBF≥0. 85, and the X2 test was used to evaluate difference of incidence of DCI between them. Statistical analysis was conducted using SPSS 16.0 software and statistical significance was accepted at P 〈 0. 05. The optimal cut-off value for each relative PCT parameter was established by receiver operating characteristic （ ROC ） curve analysis using MedCalc 9.6 2. 0 software. Results 33.3% （18/54） developed DCI. Mean relative baseline CTP values in DCI compared to no DCI groups were rCBF 0. 78 vs. 1. O1 （t =6. 63 ,P 〈0. 01 ） ,rMTT 1.24 vs. 0. 96 （ t = 5.29, P 〈 O. 01 ）, and rCBV 0. 90 vs. 1.01 （ t = 4. 43, P 〈 0. 01 ）. In DCI patients, reexamination rCBF decreased （ t = 3.18, P 〈 0.05 ）, rCBV decreased （ t = 2. 83, P 〈 0. 05 ） compare

关 键 词：动脉瘤 蛛网膜下腔出血 脑缺血 灌注 

分 类 号：R743.35[医药卫生—神经病学与精神病学]