应用CT灌注成像评价脑血管重建术对烟雾病患者短期脑血流的影响  

Effect of cerebral revascularization on cerebral blood flow in patients with moyamoya disease evaluated with CT perfusion imaging

作　　者：申伟[1,2,3] 陈谦[1,4] 黄伟[1,4] 成惠林[1,2] 杨毅卿 李维德[1,2] 马标[1,2] 杭春华[1,2] 

机构地区：[1]南方医科大学南京临床医学院 [2]南京军区南京总医院神经外科,210002 [3]解放军第一○一医院神经外科,214000 [4]南京军区南京总医院放射科,210002

出　　处：《中国脑血管病杂志》2014年第1期23-27,共5页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的应用CT灌注成像(CTP)评价脑血管重建术对烟雾病患者脑血流灌注的影响。方法采用前瞻性研究方法,对2012年6月—2013年1月就诊的14例烟雾病患者在术前和脑血管重建手术后7 d进行头部CT血管成像和CTP。对14例患者分别行联合脑血管重建术(12侧)和间接脑血管重建术(4侧)。在CTP上将术侧大脑中动脉供血皮质区作为感兴趣区(ROI),进行各参数配对t检验。结果 (1)两种血管重建术后7 d,烟雾病患者脑血流量、脑血容量均有减少,联合术式组患者对比剂达峰时间缩短,间接术式组延长,但差异均无统计学意义(P>0.05)。(2)两组患者手术后7 d对比剂平均通过时间均增加,联合术式组术前为(4.5±0.6)s,术后7 d为(4.7±0.6)s,差异有统计学意义(P=0.045)间接术式组患者对比剂平均通过时间虽增加,但差异无统计学意义。3个月时,CTP随访5例患者,影像学表现为脑血流灌注改善明显。结论 CTP检查显示联合脑血管重建术治疗烟雾病短期内可能改变脑血流灌注,但脑组织缺血状态无明显变化;间接脑血管重建术后脑血流灌注无明显改变。Objective To evaluate the effect of cerebral revascularization on cerebral blood flow in patients with moyamoya disease （MMD） with CT perfusion （CTP） imaging. Methods Fourteen patients with moyamoya disease who received head CT angiography and CTP before procedure and at 7 days after cerebral revascularization from June 2012 to January 2013 were studied prospectively. All patients received combined revaseularization （12 sides） and indirect revascularization （4 sides）. The middle cerebral artery supplied cortical areas of the surgical sides on the CTP imaging were used as regions of interest （ROI）. All the parameters were analyzed with the pair-sample t test. Results （ 1 ） At 7 days after the 2 methods of revascularizations, both cerebral blood flow and cerebral blood volume of the patients were decreased. The time to peak of the contrast agents was shortened in patients of the combined revascularization group and it was prolonged in those of the indirect revascularization group, but there was no significant difference （P 〉 0. 05 ）. （2） The mean transit time of the contrast agents was increased at 7 days after procedure in patients of both groups. The combined revascularization group was 4.5 ± 0.6 s before procedure and at 7 days after procedure was 4.7 ±0.6 s. There was significant difference （ P = 0. 045 ）. Although the mean transit time of the contrast agents was increased in the indirect revascularization group, but there was no significant difference. Conclusion The combined cerebral revascularlzation methods can increasethe cerebral blood flow perfusion in a short time; however, there is no significant change in the state of cerebral ischemia. After indirect cerebral revascularization, cerebral blood flow perfusion have no significant change.

关 键 词：脑底异常血管网病 联合脑血管重建术 间接脑血管重建术 CT灌注成像 

分 类 号：R651.1[医药卫生—外科学]