全脑CT灌注联合血管成像分析单侧颈内动脉闭塞患者脑血流代偿机制  

Whole brain perfusion and angiography in the evaluation of hemodynamic compensatory mechanism in unilateral internal carotid occlusion

作　　者：朱剑萍[1] 张洋霖 濮进敏[1] 徐勇辉[1] 孙勇[1] 刘灿丽[1] 

机构地区：[1]昆明医科大学第二附属医院放射科CT室,云南昆明650101

出　　处：《影像诊断与介入放射学》2014年第1期45-48,共4页Diagnostic Imaging & Interventional Radiology

摘　　要：目的利用全脑CT灌注(CTP)联合CT血管成像(CTA)分析单侧颈内动脉(ICA)闭塞患者的脑血流动力学变化及侧支循环情况。方法对12例单侧ICA闭塞患者行头颅CT平扫、CTP、CTA检查,以5名CTP及20例CTA正常患者的双侧眼动脉、颞浅及枕动脉血管直径作为参考值。分析病变组各灌注参数值的特点及侧支循环代偿情况。结果 4例头颅平扫阴性,CBF、CBV、MTT、TTP接近正常,侧支血管代偿良好,双侧眼动脉、颞浅、枕动脉血管直径较正常增粗约62%、64%、50%。8例出现脑梗死,CBF、CBV降低,TTP、MTT延长,侧支血管代偿不良。12例患者Willis环均不完整。结论 CTP联合CTA能很好评估单侧ICA闭塞的脑血流动力学变化及侧支循环情况,在Willis环发育不良的情况下,颅外血管及软、硬脑膜的代偿与其临床转归同样密切相关。Objective To evaluate cerebral hemodynamic changes and collateral circulation in patients with unilateral internal carotid artery （ICA） occlusion using whole brain CT perfusion （CTP） and CT angiography （CTA）. Methods Unenhanced CT, CTP and CTA were performed on 12 patients with unilateral internal carotid occlusion. The mean diameters of the bilateral ophthalmic, superficial temporal and occipital arteries of 5 persons with normal CTP and 20 persons with normal CTA were used as reference standards. The perfusion parameters including cerebral blood flow （CBF）, cerebral blood volume （CBV）, mean transit time （MTr）, and time to peak （TI＇P） as well as the collateral circulation of 12 patients were analyzed. Results In 4 patients with unilateral ICA occlusion, unenhanced CT was normal. The CBF, CBV, MTT and rl^p were close to normal. The collateral blood supply was good with 62% increase in the diameters of bilateral ophthalmic arteries, 64% in the superficial temporal arteries and 50% in the occipital arteries compared with reference standards. In 8 patients with cerebral infarction, the CBF and CBV were decreased, whereas the TFP and MTF were delayed. The collateral blood supply was poor. CTA showed developmentally incomplete circle of Willis in all 12 patients. Conclusions CTP combined with CTA can precisely depict the cerebral hemodynamic changes and collateral circulation supply in incomplete development of the circle of Willis.

关 键 词：单侧颈内动脉 体层摄影术 x线计算机 血管造影术 血流动力学 

分 类 号：R816.2[医药卫生—放射医学]