CTPI评价亚急性期脑出血后周围组织的血流动力学变化  

Assessment of hemodymamics of perihematoma after the subacute hypertensive intracerebral hemorrhage with CT perfusion imaging

作　　者：周洁洁 陈伟建[1] 杨运俊[1] 李建策[1] 段玉霞[1] 曹国全[1] 郑葵葵[1] 

机构地区：[1]温州医科大学附属第一医院放射科,浙江温州325015

出　　处：《温州医科大学学报》2015年第10期753-757,共5页Journal of Wenzhou Medical University

基　　金：浙江省公益性技术应用研究项目(2011C23021);温州市科技局公益性研究项目(Y20140733)

摘　　要：目的：应用320排容积CT灌注成像（CTPI）研究亚急性期高血压性脑出血（HICH）后周围组织的血流动力学变化。方法：对21例HICH患者于发病后4～14 d行CTPI检查,测量脑血肿体积、脑血肿周围（边缘区、外层区）及对侧镜像区的脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）及达峰时间（TTP）,并计算相对灌注参数值r CBF、r CBV、r MTT及r TTP（患侧/健侧）。采用成组t检验对边缘区、外层区及其相应镜像区域各参数值、边缘区、外层区相对灌注参数值进行分析;采用Pearson相关性分析血肿体积、发病时间与血肿周围（边缘区及外层区）r CBF、r CBV、r MTT及r TTP的相关性。结果：亚急性期脑血肿边缘区CBF、CBV均较对侧镜像区降低,差异有统计学意义（tCBF=-4.442,PCBF〈0.01;tCBV=-4.139,PCBV〈0.01）,TTP较镜像区显著延长,差异有统计学意义（tTTP=4.030,PTTP〈0.01）,MTT较镜像区有所缩短,差异无统计学意义（tMTT=-1.631,PMTT〉0.05）。血肿外层区CBF较镜像区减低,差异有统计学意义（tCBF=-2.196,PCBF〈0.05）,MTT较镜像区延长,差异有统计学意义（tMTT=2.093,PMTT〈0.05）,CBV及TTP与镜像区对比,差异无统计学意义（tCBV=-0.776,PCBV〉0.05;tTTP=0.336,PTTP〉0.05）。血肿边缘区r CBF、r CBV均较外层区减低,差异有统计学意义（tr CBF=-2.688,Pr CBF〈0.05;tr CBV=-3.124,Pr CBV〈0.01）;r MTT较外层区缩短,差异有统计学意义（tr MTT=-2.770,Pr MTT〈0.05）;而r TTP较外层区延长,差异有统计学意义（tr TTP=3.574,Pr TTP〈0.01）。血肿体积与血肿周围r CBF、r CBV、r MTT及血肿外层区r TTP均无显著相关性,与血肿边缘区r TTP有相关性（r=0.472,P〈0.05）。发病时间与血肿周围（边缘区和外层区）r CBF、r CBV、r MTT及血肿边缘区r TTP无显著相关性,与血肿外层区r TTP有相关性（r=0.441,P〈0.05）。结论：亚急性期HICH血肿周围存在脑灌注减低,且血肿周�Objective： To study the perihematomal hemodynamics changes in patients with subacutehypertensive intracerebral hemorrhage using 320-row volume CT perfusion imaging. Methods： CTPI was per- formed in twenty-one patients from 4 days to 14 days after the onset of HICH. The volume of the hematomas was measured, and the perfusion parameter values of the marginal zone and outer zone of the intracerebral he- matoma and contralateral mirror were measured, including cerebral blood flow （CBF）, cerebral blood volume （CBV）, mean transit time （MTT） and time-to-peak （TTP）, and rCBF, rCBV, rMTT and rTTP were calculated by ipsilateral/contralateral value. The differences of perfusion parameter values between the marginal zone or the outer zone and the mirror area, and the differences of relative perfusion parameters values between marginal and outer zone were analyzed by paired samples t test. Relationships between the volume of hematomas and the time from the onset to the CTPI performance and rCBF, rCBV, rMTT and rTTP of marginal and outer area were analyzed by Pearson correlation analysis. Results： （1） Compared with the mirror area, the CBF and CBV of the marginal zone showed lower perfusion and there was significant statistical difference （tcBF=-4.442, PCBF〈0.01;tCBF=-4.139, PCBV〈0.01）, the TTP was more delayed in the marginal zone, and there was significant statistical dif- ference （tTTp=4.030, PTTp〈0.01）, and the MTT of marginal zone was shorter but there was no significant statistical difference （tMTT=-1.631, PMTT〉0.05）; The CBF of the outer zone presented lower perfusion than the mirror area and there was significant statistical difference （tcBF=-2.196, PCBF〈0.05）, MTT was longer than that of the mirror area, there was significant statistical difference （tMrr=-2.093, PMTr〈0.05）, and there was no statistically differ- ence between the CBV or TTP of outer and mirror area （tcBv=-0.776, PcBv〉0.05 and tTTp=0.336, PTTP〉0.05）. The rCBF and rCBV in the marginal zone

关 键 词：脑出血 亚急性期 体层摄影术 X线计算机 灌注 

分 类 号：R445.3[医药卫生—影像医学与核医学]