全脑CT灌注成像联合CT血管成像评估动脉瘤夹闭和血管内介入术后缺血并发症  

Whole-brain CT perfusion imaging and CT angiogiaphy in the evaluation of ischemic complications associated with neurosurgical clipping and endovascular coiling for cerebral aneurysms

作　　者：程晓青[1] 陈谦[1] 周长圣[1] 李建瑞[1] 黄伟[1] 卢光明[1] 

机构地区：[1]南京军区南京总医院医学影像科,南京210002

出　　处：《放射学实践》2015年第7期710-715,共6页Radiologic Practice

基　　金：国家自然科学基金青年科学基金项目(81201072);南京军区南京总医院院内课题资助项目(2013054)

摘　　要：目的:采用全脑CT灌注成像(WB-CTPI)联合CT血管成像(CTA)从血管解剖形态和脑血流动力学方面对颅内动脉瘤显微手术夹闭和血管内介入术后血管损伤导致的缺血并发症进行分类和早期诊断。方法:58例颅内动脉瘤破裂显微手术或血管介入术后出现神经功能损伤或临床怀疑有缺血并发症的患者行动态容积CT扫描,并行WB-CTPI和CTA重组。通过CTA评估父血管或分支血管与血管夹或弹簧圈的关系。WB-CTPI定量测量患者患侧与对侧脑血流动力学参数,采用配对t检验进行统计学分析。结果:58例患者中,15例经WB-CTPI证实有缺血并发症,CTA按血管损伤情况分为:Ⅰ型6例,血管夹或弹簧圈导致父血管狭窄,其中2例CBF降低,CBV降低或正常,4例CBF与CBV正常,6例患者TTP、TTD和MTT均延长;Ⅱ型2例,血管夹导致父血管或分支血管闭塞,CBF和CBV降低,TTP、TTD和MTT延长;Ⅲ型7例,不明原因或无法判断的血管损伤,CBF降低,CBV降低或正常,TTP、TTD和MTT明显延长。结论:WBCTPI联合CTA不仅能够对血管损伤进行分型,还能够根据血流动力学损伤情况进行脑梗死预测,指导临床治疗。Objective：This study was aimed to classify and early detect by whole-brain CT perfusion imaging（WBCTPI）combined with CT angiography（CTA）for the ischemic complications associated with microsurgical clipping and endovascular coiling for cerebral aneurysms.Methods：Fifty-eight patients with cerebral aneurysms who had neurological deterioration or suspected ischemic complications after microsurgical clipping and endovascular coiling underwent both WB-CTPI and CTA exams.The relationship between clipping or coiling and parent or perforating arteries were evaluated with CTA.The value of cerebral blood flow,cerebral blood volume（CBV）,time to peak（TTP）,time to delay（TTD）and mean transit time（MTT）were measured quantitatively with WB-CTPI.The statistical differences between hemodynamic parameters of the involved cerebral hemispheres and contralateral hemispheres were analyzed using Student＇s paired t-test.Results：As for the total 58 patients,15patients with ischemic complications were confirmed by WB-CTPI and then divided into types Ⅰ,Ⅱ andⅢ according to CTA findings.Six patients of typeⅠ had reduction in the diameter of the parent vessels,including two patients with decreased ipsilateral CBF,decreased or normal CBV,four patients with normal ipsilateral CBF and CBV.However TTP,TTD and MTT were increased compared to the contralateral side in the 6patients.Two patients of typeⅡ had occlusion in the parent vessels or perforating arteries with decreased ipsilateral CBF and CBV,increased TTP,TTD and MTT compared with the contralateral side.Seven patients of typeⅢ had unexplained or indistinguishable vascular injuries with decreased ipsilateral CBF,decreased or normal CBV,increased TTP,TTD and MTT compared to the contralateral side.Conclusion：WB-CTPI combined with CTA not only can evaluate the relationship between the parent or branch vessels and clipping or coiling and classify ischemia complications,but also can predict cerebral infarctions according to hemodynamic patterns and guide

关 键 词：颅内动脉瘤 灌注 CT血管成像 缺血 

分 类 号：R816.1[医药卫生—放射医学] R743[医药卫生—临床医学]