320排CTP及CTA对窦旁脑膜瘤瘤周水肿发生机制及其临床应用价值的研究  

Mechanism and clinical value of 320-slice CT perfusion and CT angiography in peritumoral edema of parasagittal meningiomas

作　　者：殷长江[1] 张荣伟[2] 

机构地区：[1]山东省交通医院神经外科,济南250031 [2]济南军区总医院神经外科,济南250031

出　　处：《中华神经医学杂志》2016年第9期896-900,共5页Chinese Journal of Neuromedicine

摘　　要：目的应用320排CT脑灌注成像和螺旋CT血管成像探讨矢状窦旁脑膜瘤瘤周水肿发生的机制及其在临床的应用价值。方法选取自2010年5月至2015年1月期间收治于济南军区总医院神经外科的影像学诊断为良性矢状窦旁脑膜瘤的66例患者．根据颅脑MRI的T2相表现分为无瘤周水肿（22例）与瘤周水肿组（42例）。66例患者术前均行320排CTP及CTA扫描检查，扫描所得数据经处理得到脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）及达峰时间（TTP）等灌注参数，比较2组瘤组织TTP数值的差异，由参数生成脑灌注图像、CTA图像及融合图．观察瘤周引流静脉腔径变化及矢状窦的侵及情况。结果2组中瘤周水肿组的瘤周组织（分别距离肿瘤边缘0．5cm、1．5cm）的TTP数值[（28．1±3．3）s、（24．5±2．8）s]要明显大于无瘤周水肿组的TTP数值（14．8±1．3）s，差异有统计学意义沪〈0．05）；对比图像融合发现，瘤周水肿组肿瘤引流静脉腔径变宽，形态迂曲，而入窦前部分腔径相对变细，形态挺直，表明引流不畅。结论肿瘤组织及瘤旁脑组织的TTP延长是伴发瘤周水肿脑膜瘤灌注扫描的重要特征表现；肿瘤组织血液回流不畅是瘤周水肿发生的可能机制；融合图对临床手术方案的制定有指导意义。Objective To explore the mechanism and clinical value of 320-slice CT perfusion （CTP） and CT angiography （CTA） in peritumoral brain edema ofparasagittal meningiomas. Methods Sixty-six patients diagnosed as having benign parasagittal meningioma by imaging in our hospital from May 2010 to January 2015 were divided into non-peritumoral edema group （n=22） and peritumoral edema group （n=42） according to the cerebral MR T2 phase imaging. All patients were given 320-row CTP and CTA scan before surgery, and cerebral blood flow （CBF）, cerebral blood volume （CBV）, mean transit time （MTT） and time to peak （TTP） were obtained; and then, generated perfusion images and CTA images and fusion image were created. Results TTP ofperitumoral tissues from the tumor margin 0.5 cm and 1.5 cm was [（28.1±3.3） s and （24.5±2.8） s, respectively in the peritumoral edema group, which was significantly longer than that in the non-peritumoral edema group （[14.8±1.3] s, P〈0.05）. Via comparison of the fused image, the lumen diameter of tumor-draining venous widened and shaped in appearance, and became relatively thin and straight in appearance in lumen diameter before entering the sinus, which suggested that the drainage was not free. Conclusion The TTP extension of tumor tissues and peritumoral brain tissues is the important characteristic for CTP scanning of peritumoral edema in meningiomas; poor blood return of tumor tissues may be the mechanism of peritumoral edema in meningiomas; fusion image has an important guiding significance for clinical surgery.

关 键 词：320排CT脑灌注成像 螺旋CT血管成像 矢状窦旁脑膜瘤 瘤周水肿 

分 类 号：R739.45[医药卫生—肿瘤]