经颅超声造影评价脑出血血肿周围水肿区血流灌注的临床价值  

Transcranial Contrast-Enhanced Sonography in the Assessment of Blood Flow Perfusion of Perihematomal Edema in Patients with Intracerebral Hemorrhage

作　　者：金占强[1,2] 于腾飞 何文[1] 冯浩[3] JIN Zhanqiang;YU Tengfei;HE Wen;FENG Hao(Department of Ultrasound,Beijing Tiantan Hospital Affiliated to Capital Medical University,Beijing 100050;不详)

机构地区：[1]首都医科大学附属北京天坛医院超声科,北京100050 [2]桂林医学院附属医院超声科,广西桂林541001 [3]首都医科大学附属北京天坛医院神经内科,北京100050

出　　处：《中国医学影像学杂志》2020年第6期416-421,共6页Chinese Journal of Medical Imaging

基　　金：中国医师协会超声医师科技新星计划项目(2015C);北京市博士后工作经费资助项目(2017-zz-124)。

摘　　要：目的评估脑出血后血肿周围水肿区的血流灌注,明确血肿周围水肿区存在早期灌注减少的情况。资料与方法采用经颅超声造影(CE-TCCS)通过颞骨窗探查59例脑出血患者的血肿及血肿周围水肿(PHE),绘制时间-强度曲线以定量评估PHE及水肿周围脑组织的血流灌注,获得感兴趣区内的造影剂到达时间(TTA)、达峰时间(TTP)和绝对峰值强度(API)。采用90天改良Rankin量表评分判断患者功能预后。结果CT测得的血肿体积为11.58(7.72,18.20)ml;PHE绝对体积为12.90(8.18,24.48)ml,相对体积为1.28(0.72,2.12)。血肿体积与脑出血患者功能预后无显著相关性(r=0.043,P=0.748),但PHE绝对体积与相对体积与功能预后均有相关性(r=0.321,P=0.014;r=0.359,P=0.006)。血肿周围水肿区TTA、TTP较水肿周围正常脑组织明显延长[(13.51±5.66)s比(11.07±3.99)s,t=2.708,P=0.008;(21.15±6.25)s比(18.13±5.78)s,t=2.720,P=0.008],API较水肿周围正常脑组织明显降低[(6.95±2.96)dB比(9.34±4.07)dB,t=3.605,P=0.000]。PHE绝对与相对体积均与TTA无显著相关性(r=0.048,P=0.716;r=-0.100,P=0.451),而与TTP及API均具有相关性;血肿体积与TTA、TTP及API均无相关性。预后良好的患者PHE与水肿周围脑组织的TTA、TTP差异无统计学意义(P>0.05);但两者API差异有统计学意义(P<0.05)。预后不良患者的PHE与水肿周围脑组织的TTA、TTP及API差异均有统计学意义(P<0.05)。结论超声造影可以较准确地识别PHE及其范围,并对其内血流灌注进行评价。API可作为反映脑出血患者脑血流变化的可靠指标。Purpose To evaluate the cerebral perfusion of perihematomal edema(PHE)in patients with intracerebral hemorrhage,and to understand whether there is a hypoperfusion in the PHE region.Materials and Methods Transcranial ultrasound contrast was used to investigate the hematoma and PHE of 59 patients with cerebral hemorrhage through the temporal bone window,and the time-intensity curve was drawn to quantitatively evaluate the blood flow perfusion of PHE and edema brain tissue to obtain time to arrival(TTA),time to peak(TTP)of the contrast agent and absolute peak intensity(API)in the region of interest.The 90-day modified Rankin scale score was used to judge the functional prognosis of patients.Results The volume of hematoma measured by CT was 11.58(7.72,18.20)ml;the absolute volume of PHE was 12.90(8.18,24.48)ml,and the relative volume was 1.28(0.72,2.12).There was no significant correlation between the volume of hematoma and functional prognosis of patients with cerebral hemorrhage(r=0.043,P=0.748),but the absolute volume and relative volume of PHE were correlated with functional prognosis(r=0.321,P=0.014;r=0.359,P=0.006).TTA and TTP in the edema area around the hematoma were significantly longer than the normal brain tissue around the edema[(13.51±5.66)s vs.(11.07±3.99)s,t=2.708,P=0.008;(21.15±6.25)s vs.(18.13±5.78)s,t=2.720,P=0.008],API was significantly lower than normal brain tissue around edema[(6.95±2.96)dB vs.(9.34±4.07)dB,t=3.605,P=0.000].The absolute and relative volume of PHE had no significant correlation with TTA(r=0.048,P=0.716;r=-0.100,P=0.451),but had correlation with TTP and API;hematoma volume had correlation with TTA,TTP and API.In patients with a good prognosis,there was no statistically significant difference in TTA and TTP between PHE and brain tissue around edema(P>0.05);but the API difference between the two was statistically significant(P<0.05).Differences in TTA,TTP and API between PHE and brain tissue around edema in patients with poor prognosis were statistically significant(P<0.05).Co

关 键 词：脑出血 血肿 脑水肿 超声检查 造影剂 血液灌注 

分 类 号：R445.1[医药卫生—影像医学与核医学] R743[医药卫生—诊断学]