全脑一站式CTA-CTP对脑动静脉畸形的临床价值探讨  

Clinical application value of whole-brain CTA-CTP imaging in cerebral arteriovenous malformation

作　　者：耿悦[1] 王剑[1] 周浩[1] 曾蒙苏[1] 

机构地区：[1]复旦大学附属中山医院放射诊断科上海市影像医学研究所,上海200032

出　　处：《实用放射学杂志》2016年第12期1834-1837,共4页Journal of Practical Radiology

摘　　要：目的：探讨全脑一站式CT血管成像-CT灌注成像（CTA-CTP）对脑动静脉畸形（cAVM）的临床应用价值。方法回顾性分析15例经一站式CTA-CTP诊断为 cAVM患者的临床及影像学资料。记录四维CT血管成像（4D-CTA）所示病灶瘤巢、供血动脉及引流静脉的解剖细节；比较13例4D-CTA与数字减影血管造影（DSA）的影像学表现，判断其诊断价值。定量测定瘤巢及瘤周脑实质的灌注参数。分析病灶解剖构筑、血流灌注特征与颅内出血的相关性。结果4D-CTA能够动态显示 cAVM病灶的解剖构筑细节及对比剂进出瘤巢的整个过程，与DSA诊断一致性较高，但对一些细小供血动脉或引流静脉显影欠佳。13例瘤巢呈高灌注，瘤周“盗血”呈低灌注；2例病灶因局部血肿存留呈低灌注。9例患者既往发生颅内出血，出血组瘤巢最大径〈3 cm、单支动脉供血、深静脉引流、瘤巢平均通过时间（MTT）延长、瘤周 MTT 缩短的比例高于未出血组（P〈0.05）。结论全脑一站式 CTA-CTP在 cAVM无创性诊断及出血高危因素预测方面具有潜在的临床价值。Objective To explore the clinical application value of whole-brain CTA-CTP imaging in cerebral arteriovenous malformation （cAVM）.Methods Fifteen patients diagnosed with cAVM by CTA-CTP imaging were included in this retrospective analysis study. The angioarchitecture of cAVM lesions were recorded from 4D-CTA images.Using DSA as the golden standard,the diagnostic accuracy of 4D-CTA was evaluated in 13 cases.The perfusion patterns of vessel nidus and peritumoral tissues were analyzed from the CTP images.Bleeding ratios of patients with different angioarchitecture and perfusion patterns were compared.Results 4D-CTA could dynamically display the angioarchitecture details of cAVM lesions and show the whole process of the contrast agent in and out of the vessel nidus.Although the result of 4D-CTA was consistent with that of DSA in most cases,a few fine feeding arteries and draining veins were missed.The nidus in thirteen cases was with high perfusion and the peritumoral tissues were with low perfusion.Another two cases were with low perfusion due to the presence of hematoma.Nine cAVMs suffered from small size,single feeding artery,deep venous drainage and vessel nidus with increased MTT,peritumoral tissues with decreased MTT were more likely to suffer a hemorrhage （P〈0.05）.Conclusion Whole-brain CTA-CTP imaging could be a valuable adjunct in noninvasive diagnosis of cAVM and predicting the bleeding risk factors.

关 键 词：计算机体层成像 灌注成像 血管造影术 脑动静脉畸形 

分 类 号：R814.42[医药卫生—影像医学与核医学] R814.43[医药卫生—放射医学]