脑CT灌注成像联合颈动脉高分辨磁共振成像在颅外段颈动脉狭窄诊断及支架成形术中的应用  

Evaluation of cranial CT perfusion combining with carotid artery high-resolution magnetic resonance imaging in diagnosis of extracranial carotid stenosis and carotid stenting

作　　者：郭旭[1,2] 博力杨[1,3] 毕齐[1,2] 刘悦[1,2] 王力锋[1,2] 范承哲[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所神经内科,100029 [3]北京市心肺血管疾病研究所脑卒中科,100029

出　　处：《心肺血管病杂志》2015年第8期606-610,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨脑CT灌注成像(CTP)联合颈动脉高分辨磁共振成像(HR-MRI),在颈动脉狭窄诊断及支架置入术中的评估价值。方法:经颈动脉B超证实颅外段颈动脉重度狭窄90例患者,行脑CTP联合颈动脉HR-MRI检查,对结果分析、评估基础上,选取合适的颈动脉支架置入。结果:共筛查85例症状性颈动脉狭窄患者为颈动脉内膜剥脱术的高危患者,其中CTP异常75例。最终64例颈动脉狭窄患者存在易损斑块(含纤维帽破裂、斑块内出血),行闭环自膨支架治疗,余21例患者行开环自膨支架置入,术中所有患者使用保护伞装置。手术成功率97.6%,围手术期内出现1例脑叶出血、1例下肢静脉血栓,未发生缺血性脑血管病。结论:脑CTP联合颈动脉HR-MRI可充分评估颈动脉狭窄程度,并了解狭窄段管腔斑块成分,为颈动脉支架的选择及降低围手术期风险提供重要指导。Objective： To discuss the value of application in cranial CT Perfusion （CTP） combining with high-resolution magnetic resonance imaging（HR-MRI） in diagnosis of carotid stenosis and carotid stenting. Methods：90 cases verified by extracranial carotid ultrasound received cranial CTP and carotid artery HR-MRI and then analyzed results. It would be available in choosing suitable stent for different patients. Results：85 cases of symptomatic carotid stenosis were screened-at high risk for Carotid Endarterectomy（CEA）. CTP were abnormal in 75 patients. 64 cases were screened for vulnerable plaques in carotid arteries（ i. e. ruptured fiber cap or intraplaque hemorrhage） and were performed with closed-cell self-expanding stent. Another 21 patients were performed with open-cell self-expanding stent. All cases applied with embolic protective device. The success rate of the procedure was97.6%. A case suffered from Parietal lobe hemorrhage and one another was diagnosed for acute femoral venous thrombosis. There was no ischemic cerebral vascular event in perioperative period. Conclusion ： The stenosis rate and endovascular plaque composition of stenosis carotid were accurately estimated by cranial CTP and carotid HR-MRI. The combined method will guide to choose the type of stent and could be reduce risks of patients in the perioperative period.

关 键 词：脑灌注成像 磁共振成像 颈动脉狭窄 血管造影术 血管成形术 

分 类 号：R54[医药卫生—心血管疾病]