超急性期脑梗死后交叉性小脑神经机能联络不能的CTP研究  

Crossed cerebellar diaschisis detected by whole brain CT perfusion in hyperacute ischemic stroke

作　　者：郑凯 张苗[1,2] 於帆 单艺 李岩[1,2] 郭道德 卢洁[1,2,3] ZHENG Kai;ZHANG Miao;YU Fan;SHAN Yi;LI Yan;GUO Daode;LU Jie(Department of Radiology,Xuanwu Hospital,Capital Medical University,Beijing 100053,P.R.China;Beijing Key Laboratory of Megnetic Resonance Imaging and Brain Informatics,Beijing 100053,P.R.China;Department of Nuclear Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,P.R.China)

机构地区：[1]首都医科大学宣武医院放射科,北京100053 [2]磁共振成像脑信息学北京市重点实验室,北京100053 [3]首都医科大学宣武医院核医学科,北京100053

出　　处：《医学影像学杂志》2021年第2期177-182,共6页Journal of Medical Imaging

基　　金：国家自然科学基金面上项目(编号:81671662);北京市医院管理局“登峰”人才培养计划专项经费资助项目(编号:DFL20180802)。

摘　　要：目的应用脑CT灌注(CT perfusion,CTP)成像技术评价超急性期脑梗死(HIS)后交叉性小脑神经机能联络不能(CCD)的改变,并初步探讨其发生机制。方法回顾性分析66例超急性期单侧幕上脑梗死患者,所有患者均行全脑CTP检查,将对侧小脑半球出现至少两个层面灌注异常定义为CCD阳性,将所有患者分为CCD阳性组和CCD阴性组。分别比较CCD阳性组和阴性组患者两侧小脑半球各项灌注参数的差异,以及幕上异常灌注范围、运动功能和临床因素的差异;并分析CCD阳性患者幕上灌注异常范围、运动功能与CCD严重程度的相关性。结果66例患者中CCD阳性38例,CCD阴性28例,统计学分析显示CCD阳性患者两侧小脑半球各灌注参数值均有显著性差异(P<0.05)。CCD阳性组患者幕上异常灌注体积大于CCD阴性组(P<0.05),患者运动功能降低较CCD阴性组更为显著,差异有统计学意义(P<0.05),但幕上异常灌注体积及运动功能与CCD的严重程度均无明显相关性(P>0.05)。两组患者的性别、年龄及发病至CTP检查时间差异无统计学意义(P>0.05)。结论脑CTP成像技术能够评价HIS后CCD改变。患者幕上脑灌注异常体积及临床运动功能与CCD的发生有关,但与CCD严重程度无关。Objective To evaluate the phenomenon of the crossed cerebellar diaschisis(CCD)after hyperacute ischemic stroke as well as the mechanism with whole brain CT perfusion imaging.Methods We retrospectively analyzed 66 patients with hyperacute ischemic stroke.All patients were performed whole-brain CTP.At least two levels of abnormal perfusion in the contralateral cerebellar hemisphere were defined as CCD positive,and all patients were divided into CCD positive group and CCD negative group.The perfusion parameters on both sides of cerebellar hemisphere on CCD-positive and CCD-negative patients were analyzed.The volume of supratentorial abnormal perfusion,motor function and clinical factors were compared in the CCD-positive and CCD-negative group.The correlation between the volume of abnormal perfusion,the motor function and the severity of CCD was analyzed.Results Among the 66 patients,38 were defined as CCD positive,while 28 were defined as CCD negative.There were significant differences in the perfusion parameters of both sides of cerebellar hemispheres in the CCD-positive patients(P<0.05).The volume of supratentorial abnormal perfusion in the CCD-positive group was larger than that in the CCD-negative group(P<0.05),and the motor impairment in the CCD-positive patients was more significant than that in the CCD-negative group(P<0.05).There was no significant correlation between the volume of supratentorial abnormal perfusion,motor function and the severity of CCD(P>0.05).There was no significant difference in gender,age and the time from symptom onset to CTP between the two groups(P>0.05).Conclusion Whole brain CTP imaging can effectively evaluate the phenomenon of CCD after hyperacute ischemic stroke.Motor function and the volume of abnormal supratentorial cerebral perfusion are related to the occurrence of CCD,but not to the severity of CCD.

关 键 词：超急性期脑梗死 交叉性小脑神经机能联络不能 体层摄影术 X线计算机 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R814.42[医药卫生—临床医学]