动脉瘤性蛛网膜下腔出血后周围脑实质CT灌注变化分析  

Analysis of changes of cerebral perfusion in surrounding brain parenchyma after aneurismal subarachnoid hemorrhage

作　　者：童秋云[1,2] 李瑞[1] 陈伟建[1] 杨运俊[1] 林怡[1] 吴楠[1] 王殊[1] 王宏清[1] 许化致[1] 段玉霞[1] 郭翔[1] 张辉[1] 

机构地区：[1]温州医科大学附属第一医院放射科,325000 [2]广西桂林医学院附属医院放射科

出　　处：《中华神经外科杂志》2014年第1期50-55,共6页Chinese Journal of Neurosurgery

基　　金：浙江省级公益性技术应用研究计划项目（2011C23021）

摘　　要：目的比较动脉瘤性蛛网膜下腔出血（aSAH）后24h内及6～8dSAH周围脑实质cT灌注变化情况，以探讨cT灌注成像在预测延迟性脑缺血（DCI）中的应用价值。方法回顾性分析温州医科大学附属第一医院2011年12月至2012年12月期间32例aSAH患者的影像学资料。所有患者发病24h内均行颅脑CT平扫、CT血管成像（CTA）及CT灌注成像（CTP）一站式检查，发病6～8d复查颅脑CT平扫及CTP。测量患者先、后两次CTP检查低灌注区域或SAH周围及其镜像脑实质区域的灌注参数值，包括脑血流量（CBF）、脑血容量（CBV）及平均通过时间（Mar），计算低灌注区域或SAH周围脑实质及其镜像脑实质区域的各参数比值，获得相对脑血流量（rCBF）、相对脑血容量（rCBV）及相对平均通过时间（rMIT）。32例患者根据其有无发生DCI，分为DCI患者组（8例）及非DCI患者组（24例）。采用独立样本t检验比较两组之间患者前后两次CTP检查低灌注区域或SAH周围脑实质的rCBF、rCBV及rMIT的差值的差异。结果DCI组首次检查低灌注区域或SAH周围脑实质的rCBF、rCBV及rMTT分别为1．1±0．3、1．1±0．5及1．1±0．2，复查时对应数值为0．7±0．2、0．9±0．2及1．5±0．3；非DCI组首次检查rCBF、rCBV及rMTT分别为0．9±0．3、1．0±0．2及1．1±0．2，复查时对应数值为0．9±0．2、0．9±0．2及1．1±0．2。DCI组复查与首次检查对比，rCBF降低、rMTY延长，而非DCI组虽部分患者灌注好转，但总体rCBF、rCBV及rMTr变化不明显，两组间复查与首次检查相比，rCBF及rMTT的差值有统计学意义（trCBF=2．659，PrCBF=0．012；trMTY=-3．747，PrMTT=0．001），但两组间前后两次检查rCBV对比差异无统计学意义（trCBV=1．031，PrCBV=0．311）。结论CTP参数rCBF及rMIT值敏感性较高，对预测DCI的发生有重要意义，有利于临床诊疗方案的制定。Objective To study cerebral perfusion in surroundin gbraln parenchyma within 24 hours and 6 - 8 days after aneurysmal subarachnoid hemorrhage （aSAH） by CT perfusion imaging, to explore the applied value of CT perfusion imaging in predicting delayed cerebral ischemia （DCI）. Methods Imaging data of 32 consecutive aSAH patients of our hospital during December 2011 to December 2012 were retrospectively reviewed. All patients underwent non - contrast CT, CT angiography （CTA） and CT perfusion （CTP） imaging within 24 hours of onset. 6 - 8 days after SAH, only non - contrast CT and CTP could be performed. The perfusion parameters values in hypoperfusion area or surrounding brain parenchyma of SAH and the mirror parenchyma were measured for the first and follow - up CTP, including cerebral blood flow （CBF）, cerebral blood volume （CBV）, mean transit time （MTY）. To calculate the ratio of the two parts to get the relative cerebral blood flow（rCBF）, relative cerebral blood volume （rCBV） and relative mean transit time（rMTF）. According to presence of DCI, 32 patients were divided into DCI group （8 patients） and no - DCI group（24 patients）. The differences of rCBF,rCBV and rMTI＂ of the two examination between the two group were compared with independent - sample t test. Results For the DCI group, rCBF was 1.0 ± 0. 3, rCBV was 1.1 ±0.5 and rMTT was 1.1 ±0.2 in the first CTP,rCBF was 0.7 ±0. 2,rCBV was 0.9 ±0,2 and rMTF was 1.5 ± 0. 3 in the follow - up CTP. For the no - DCI group, rCBF was0. 9 ± 0. 3, rCBV was 1.0 ±0. 2 and rMTY wasl. 1 ±0. 2 in the first CTP,rCBF was 0.9 ±0. 2,rCBV was 0. 9 ±0. 2 and rMTr was 1.1 ± 0. 2 in the follow - up CTP. Compared with the first CTP, there was lower rCBF, stable rCBV and higher rMTF in the follow - up CTP for the DCI group. Although perfusion was improved in some patients, but there were no significant changes overall for the rCBF, rCBV and rMrl± for the twice CTP. There was significant statistical difference in the differences

关 键 词：蛛网膜下腔出血 体层摄影术 X线计算机 灌注 延迟性脑缺血 

分 类 号：R743.3[医药卫生—神经病学与精神病学]