CT灌注成像评估急性自发性脑出血周围组织血流动力学变化  

CT perfusion imaging evaluation on hemodynamic changes of acute spontaneous intracerebral hemorrhage surrounding tissues

作　　者：匡祎[1] 陈伟建[1] 郑葵葵[1] 付军[1] 胡子龙[1] 杨运俊[1] 戴一川 

机构地区：[1]温州医科大学附属第一医院放射影像中心,325000

出　　处：《中华医学杂志》2015年第43期3514-3518,共5页National Medical Journal of China

基　　金：浙江省级公益性科技计划（2011C23021）

摘　　要：目的 应用320排低剂量容积CT灌注成像研究幕上急性（72 h以内）自发性脑出血后周围组织的血流动力学变化.方法 2012年12月至2013年12月温州医科大学附属第一医院对26例（男15例,女11例,年龄30-79岁,平均年龄55.7岁）CT平扫确诊为急性幕上自发性脑出血的患者行CT灌注成像（CTPI）检查.以血肿的最大层面为参照,测量脑血肿周围（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rCBF、rCBV、rMTT及rTTP（患侧/健侧）,用自带软件手动测量血肿体积及血肿周围灌注缺损面积,CT平扫图上最大血肿层面手动测量水肿面积.结果 26例急性期血肿边缘区CBF、CBV较对侧镜像区减低（tCBF=-8.125、tCBV=-8.671,PCBF、CBV＜0.01）;MTT较对侧镜像区缩短（tMTT=-3.246,PMTT＜0.05）;TTP较对侧镜像区延长（tTTP=5.027,PTTP＜0.01）.血肿外层区CBV较对侧镜像区减低（tCBV=-2.337,PCBV ＜0.05）;MTT较对侧镜像区缩短（tMTT=-2.421,PMTT＜0.05）;TTP较对侧镜像区延长（tTTP=2.077,PTTP＜0.05）;CBF与对侧镜像区对比差异无统计学意义（tCBF=-1.658,PCBV ＞0.05）.急性期血肿边缘区rCBF、rCBV低于外层区（trCBF=-8.816,PCBF＜0.01及trCBV=-6.510,PrCBV ＜0.01）;血肿边缘区rTTP较外层区延长（trTP=4.204,PrTTP ＜0.01）.血肿体积与血肿边缘区rCBV、rMTT呈直线负相关,与rTTP呈直线正相关（rCBV=-0.412,PrCBV ＜0.05,rrMTT=-0.437,PrMTT＜0.05,rrTTP=0.475,PrTTP＜ 0.05）;血肿体积与血肿周围CBF灌注缺损面积呈直线正相关（r =0.440,P＜0.05）.最大血肿层面周围水肿面积与血肿体积、血肿周围CBF灌注缺损面积呈直线正相关（r =0.400,r=0.815,P＜0.05）.结论 320排低剂量容积CT灌注成像能够较好的反映急性幕上自发性脑出血后周围组织的血流动力学变化;血肿周边存在明显的低灌注区,且与血肿的体积相关Objective To discuss the hemodynamic changes in patients with acute supratentorial spontaneous intracerebral hemorrhage （within 72 hours） by using 320-slice of low-dose volume CT perfusion imaging.Methods Twenty-six patients of The First Affiliated Hospital of Wenzhou Medical University during December 2012 to December 2013 with acute supratentorial SICH diagnosed by plain CT scanning and clinic were enrolled.With hematoma maximum level for reference, the hematoma volume, edema area and perfusion defect area were measured, and the perfusion parameters values of the marginal area and outer area of the intracerebral hematoma and contralateral mirror area 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.Results The CBF, CBV of the marginal area were lower than the contralateral mirror area （tCBF =-8.125, tCBV =-8.671, PCBF,CBV 〈0.01）;the MTT of the marginal area was shorter than the contralateral mirror area （tMTT =--3.246, PMTT 〈 0.05）;the TTP of the marginal area was longer than the contralateral mirror area （tTTP =5.027, PTTP 〈 0.01）.The CBV of the outer area was lower than the contralateral mirror area （tCBv =-2.337, PCBV 〈 0.05）;the MTT of the outer area was shorter than the contralateral mirror area （tMTT =-2.421, PMTT 〈 0.05）;the TTP of the outer area was longer than the contralateral mirror area （tTTP =2.077, PTTP 〈 0.05）.There was a siginificant relationship between the volume of acute hematoma and rCBV, rMTT, rTTP of the marginal area （rrCBv =-0.412, PrCBv 〈 0.05, rrMTT =--0.437, PrMTT 〈 0.05, rrTTP =0.475, PrMTT 〈 0.05）.Perihematomal CBF perfusion defect area showed a positive linear relation with the volume of acute hematoma （r =0.440, P 〈 0.05）.There was a positive linear relationship between the maximum level edema area and the hematoma volume, perihematomal CBF perfusion d

关 键 词：脑出血 体层摄影术 X线计算机 脑水肿 

分 类 号：R816.1[医药卫生—放射医学] R743.34[医药卫生—临床医学]