CT灌注联合血管成像鉴别颅内动脉瘤术后血管痉挛和损伤导致的缺血并发症  

Comparison between Vasospasm and Vascular Injury Associated Ischemic Complication After Treatment of Intracranial Aneurysm by Whole Brain CT Perfusion and Angiography

作　　者：程晓青[1] 陈谦[1] 李建瑞[1] 周长圣[1] 方晓堃 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,210002

出　　处：《临床放射学杂志》2015年第9期1360-1366,共7页Journal of Clinical Radiology

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

摘　　要：目的利用全脑CT灌注(WB-CTP)联合CT血管成像(CTA)从血管解剖形态和脑血流动力学方面鉴别动脉瘤术后血管痉挛和损伤造成的缺血并发症。方法前瞻性搜集动脉瘤破裂行显微手术夹闭和血管内介入术后出现神经功能损伤或怀疑有缺血并发症的58例患者,行动态容积CT扫描,并重组WB-CTP和CTA。CTA被用来对比血管痉挛及损伤的解剖学不同。WB-PCT定量评估脑血流量(CBF),血容量(CBV),达峰时间(TTP)等参数,对比血流动力学差异。结果 WB-CTP与CTA证实痉挛导致的缺血并发症15例,其中局限性痉挛9例,广泛性痉挛6例;血管损伤导致的缺血并发症15例。CTA可通过病变发生部位、远端血管改变及随访进行鉴别。此外,广泛性痉挛多个供血区出现灌注异常,易与血管损伤鉴别。局限性痉挛与血管损伤脑血流动力学改变可分为代偿期、失代偿前期及失代偿期,母血管或分支血管闭塞及不明原因或伪影干扰的血管损伤可能更易造成失代偿期改变。结论 WB-CTP与CTA改变,结合症状出现时间及脑梗死的解剖分布能够对血管痉挛和损伤造成的缺血并发症进行鉴别。Objective To investigate the differences in vascular anatomy and cerebral hemodynamics in vasospasm or vascular injury in patients treated for intracranial aneurysms by whole brain perfusion CT（ WB-CTP） and CT angiography（ CTA）. Methods A total of 58 aneurysm patients who underwent clipping or coiling with postoperative neurological deterioration or suspected ischemic complications were examined by WB-CTP. Data were also used for reconstruction of CTA,which was used to assess vasospasm and the positional relationship between the clipping or coiling to parent vessels and vascular branch. Cerebral blood flow（ CBF）,cerebral blood volume（ CBV）,time to peak（ TTP）,and so on in both the ipsilateral and contralateral sides were quantified by WB-CTP to evaluate the hemodynamic changes. Results WB-CTP and CTA findings confirmed 15 cases of vasospasm associated ischemic complications including nine cases of focal vasospasm and six cases of generalized vasospasm. In addition,there were 15 cases of vascular injury associated ischemic complication. CTA findings showed that generalized vasospasm involved stenosis of multiple vessels,whereas focal vasospasm and vascular injury were identified by the location of the diseased region,distal vascular changes and follow up examinations.WB-CTP findings demonstrated that perfusion abnormalities in patients with generalized vasospasm involved multiple vascular territories,whereas perfusion abnormalities caused by vascular injury mostly occurred in parent vessel territory. Cerebral hemodynamics changes of ischemic complications caused by either focal vasospasm or vascular injury might be divided into compensated,pre-decompensated and decompensated phases. Parent or branch vascular occlusion,and unexplained or artifacts related vascular injury often led to decompensated changes. Conclusion Ischemic complications associated with vasospasm or vascular injury can be distinguished by WB-CTP and CTA examinations,time to onset and the anatomical distribution of the cerebral

关 键 词：缺血 颅内动脉瘤 CT 灌注 血管成像 显微手术夹闭 

分 类 号：R651.1[医药卫生—外科学] R816.1[医药卫生—临床医学]