成年烟雾病患者血管重建术前后的CT灌注评价  

CT perfusion evaluation before and after revascularization in adult patients with Moyamoya disease

作　　者：宋平[1] 陈晓斌[1] 罗明[1] 丁伟 李继强[1] 蔡强[2] 王远[1] 黄从刚[1] 吴京雷[1] 段发亮[1] Song Ping;Chen Xiaobin;Luo Ming;Ding Wei;Li Jiqiang;Cai Qiang;Wang Yuan;Huang Conggang;Wu Jinglei;Duan Faliang(Department of Neurosurgery,Wuhan No.1 Hospital,Wuhan 430022,China;Department of Neurosurgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉市第一医院神经外科,430022 [2]武汉大学人民医院神经外科,430060

出　　处：《国际脑血管病杂志》2019年第3期193-200,共8页International Journal of Cerebrovascular Diseases

基　　金：湖北省卫计委科研项目(WJ2017F014).

摘　　要：目的探讨CT灌注成像(CT perfusion imaging,CTP)在成年烟雾病患者血管重建术治疗中的应用价值。方法回顾性分析2009年7月至2016年12月期间在武汉市第一医院神经外科接受血管重建术治疗的成年烟雾病患者。在术前以及术后3~6个月进行CTP检查以及临床评估,采用改良Rankin量表(modified Rankin Scale,mRS)评估功能转归情况。结果总共纳入20例患者,其中男性11例,女性9例,平均年龄53.5岁(范围2973岁。首发症状:缺血性卒中10例,短暂性脑缺血发作7例,出血性卒中3例。所有患者均在全身麻醉下行颞浅动脉-大脑中动旁路移植术+颞肌贴附术。所有患者术后脑血流均有不同程度改善,CT灌注参数较术前显著改善(P均<0.05)。术后半年临床显著改善3例(15%),恢复良好13例(65%),mRS评分0~2分的比例显著高于术前(90.0%(18/20)对50.0%(10/20);χ^2=7.619,P=0.006)。结论CTP可从血流动力学参数方面早期评估各血管区脑血流灌注状态,可有效指导烟雾病手术方式、评价术后脑灌注状态改变情况及用于病情随访。Objective To investigate the application value of CT perfusion(CTP)imaging for the revascularization treatment in adult patients with Moyamoya disease.Methods Adult patients with Moyamoya disease underwent revascularization in the Department of Neurosurgery,Wuhan No.1 Hospital from July 2009 to December 2016 were analyzed retrospectively.CTP and clinical evaluation were performed before and after 3-6 months of procedure.The modified Rankin Scale(mRS)was used to assess the functional outcomes.Results A total of 20 patients were enrolled in the study,including 9 females and 11 males,aged 29 to 73 years,with an average of 53.5 years.The initial symptom was ischemic stroke in 10 patients,transient ischemic attack in 7 patients,and hemorrhagic stroke in 3 patients.All patients underwent superficial temporal artery-middle cerebral artery bypass grafting plus encephalomyo-synangiosis under general anesthesia.All patients have different degrees of improvement in cerebral blood flow after procedure,and the CTP parameters were significantly improved compared with those before procedure(all P<0.05).The clinical symptoms were significantly improved in 3 cases(15%)and recovered in 13 cases(65%)at 6 months after procedure.The proportion of the mRS score 0-2 was significantly higher than that before procedure(90.0%[18/20]对50.0%[10/20];χ^2=7.619,P=0.006).Conclusion CTP can evaluate the cerebral perfusion status in various vascular areas through hemodynamic parameters in early stage,which can effectively guide the operation mode of Moyamoya disease,and evaluate the changes of cerebral perfusion status after procedure as a means of follow-up of the disease.

关 键 词：烟雾病 脑血管重建术 灌注成像 体层摄影术 X线计算机 治疗结果 成年人 

分 类 号：R651.1[医药卫生—外科学] R816.1[医药卫生—临床医学]