DSC-PWI联合颈动脉CTA在短暂性脑缺血发作的应用价值  

The application value of dsc-pwi combined with carotid CTA in transient ischemic attack

作　　者：王象萍 楼存诚[1] 戴月红[1] 陈狄洪[1] 王灿云[1] 张秀文[1] Wang Xiangping

机构地区：[1]杭州市萧山区第一人民医院,311200

出　　处：《浙江临床医学》2020年第12期1723-1725,共3页Zhejiang Clinical Medical Journal

基　　金：杭州市萧山区社会发展重大科技攻关项目(2017205)。

摘　　要：目的探讨脑动态磁敏感对比增强灌注成像(DSC-PWI)联合颈动脉CT血管造影(CTA)在短暂性脑缺血发作(TIA)的临床应用价值。方法38例颈内动脉狭窄性且扩散加权成像(DWI)呈阴性TIA患者入选,在发作间歇期分别行CTA、DSC-PWI检查,计算颈内动脉系统狭窄程度和脑灌注参数图,依颈动脉狭窄程度分为轻度组、中度组、重度或闭塞组,依灌注参数图分为灌注正常、1期、2期、3期,统计分析颞顶叶各参数患侧与健侧相对灌注值的统计学差异,分析狭窄程度与血流动力学改变的相关性,并记录随访结果。结果38例TIA患者中,灌注异常者有26例(68.4%),其中颈动脉重度或闭塞组23例出现在灌注成像(PWI)2期和3期,显著高于中度组、轻度组,TIA患者的颈内动脉狭窄程度与颞顶叶的灌注参数相对达峰时间(rTTP)、相对平均通过时间(rMTT)、相对脑血容量(rCBV)呈正相关(P<0.01),随访有3例在6个月内出现急性脑梗死。轻中度组TIA患者随访过程中均未见急性缺血性脑血管病事件发生。结论DSC-PWI联合颈动脉CTA检查,在基层易开展、推广,可对颈内动脉重度狭窄或闭塞患者的血流动力学改变及灌注信息进行评估,为TIA的预防、诊疗及随访提供影像学依据。Objective To evaluate the clinical application value in ITA by using Cerebral dynamic magnetic sensitivity contrast enhanced perfusion imaging(DSC-PWI)combined with carotid artery CT angiography(CTA).Methods 38 patients with transient ischemic attack(TIA)due to internal carotid artery stenosis were included,all their DWI signs were negative.CTA and DSC-PWI were peformed in the interictal period.By calculating the stenosis degree of intermal carotid artery and the Cerebral perfusion parameter diagram separately,patients were divided into three groups and four stages,namely slight,moderate and severe group,and normal,first,second and third stage.Statistical differences between relative perfusion values of afcede temporal and parietal lobes and uffcted ones were analyzed,as well as the relationship between stenosis degree and hemodynamical changes,then all these data were recorded.Results 26 cases of the 38(68.4%)TIA patients show abnormal perfusion,as to the severe or occlusion group,23 cases were found in the second and third stage,which was markedly higher than the slight and moderate groups.Positive relationship(P<0.01)was found between internal carotid artery stenosis degree and rTTP,rMTT and rCBV of perfusion parameters in temporal and parietal lobes.And 3 patients died due to acute cerebral infarction.While there was no ACI happened in the slight and moderate groups.Conclusion DSC PWI combined with intermal carotid artery CTA examination plays an ffective role in evaluating hemodynamic changes and perfusion status in patients suffer severe stenosis or occlusion,with the advantage of easily application and promotion,it is a solid base for TIA precaution,diagnosis and follow up in the primary hospital.

关 键 词：短暂性脑缺血发作 脑灌注成像 颈内动脉 血管造影术 

分 类 号：R74[医药卫生—神经病学与精神病学]