CT脑灌注评价急性Stanford A型主动脉夹层脑血流动力学改变  

CT cerebral perfusion evaluation of cerebral hemodynamic changes in acute Stanford type A aortic dissection

作　　者：李敏[1] 秦洪涛[2] 杨丽[1] 杜亚强[3] 王向明[1] 刘晶[1] LI Min;QING Hongtao;YANG Li;DU Yaqiang;WANG Xiangming;LIU Jing(Department of CT,The Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院CTMR科,050011 [2]河北医科大学第一医院放射科 [3]河北医科大学第四医院体检中心

出　　处：《心肺血管病杂志》2021年第3期270-274,290,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：河北省2019年度医学科学研究重点课题(20190094)。

摘　　要：目的:CT脑灌注在评价急性Stanford A型主动脉夹层患者的脑血流动力学改变情况。方法:前瞻性分析32例影像上诊断为急性Stanford A型主动脉夹层的患者,所有患者均进行常规头颅CT平扫,头CT灌注扫描(CTP),头颅及体部CT血管成像扫描(CTA)。并获得CTP脑血流量(CBF),脑血容量(CBV),平均通过时间(MTT)及残余功能达峰时间(Tmax)灌注参数图,CTA采用CPR,MPR重建头及体部血管。观察CTA所示的Stanford A型主动脉夹层与CTP脑灌注参数间的关系。结果:32例Stanford A型主动脉夹层患者中,双侧颈总动脉均未受累者10例,双侧受累并轻度狭窄患者8例,两侧脑灌注参数差异均无统计学意义。单侧受累(右颈总动脉)10例轻度狭窄患者中,患者脑灌注参数无统计学差异,4例中度狭窄患者中,患侧MTT与Tmax较健侧略延长,而CBF与CBV无明显变化。主动脉真腔狭窄双侧脑灌注参数无统计学意义。结论:脑灌注参数MTT与Tmax能敏感地显示急性Stanford A型主动脉夹层累及颈总动脉患者的脑血流动力学改变,是诊断脑缺血最敏感的指标,为临床早期治疗提供可靠的依据,从而预防脑卒中的发生。Objective: CT cerebral perfusion is used to evaluate the cerebral hemodynamic changes in patients with acute Stanford A aortic dissection. Methods: A prospective analysis of 32 patients with acute Stanford type A aortic dissection on imaging was performed. All patients underwent conventional head CT scan, head CT perfusion scan(CTP), and head and body CT angiography scan(CTA). And obtain CTP cerebral blood flow(CBF), cerebral blood volume(CBV), mean transit time(MTT) and residual function peak time(Tmax) perfusion parameter maps. CTA uses CPR and MPR to reconstruct the blood vessels of the head and body. Observe the relationship between Stanford A-type aortic dissection shown in CTA and CTP cerebral perfusion parameters. Results: Among the 32 patients with Stanford A type aortic dissection, 10 cases had bilateral common carotid arteries unaffected, and 8 cases had bilateral involvement with mild stenosis. There was no significant difference in cerebral perfusion parameters on both sides. Among the 10 patients with unilateral involvement(right common carotid artery) with mild stenosis, there was no significant difference in cerebral perfusion parameters. In 4 patients with moderate stenosis, the MTT and Tmax of the affected side were slightly longer than those of the healthy side, while CBF and CBV did not obvious change. The bilateral cerebral perfusion parameters of aortic true lumen stenosis were not statistically significant. Conclusions: Cerebral perfusion parameters MTT and Tmax can sensitively display the cerebral hemodynamic changes in patients with acute Stanford A aortic dissection involving the common carotid artery. They are the most sensitive indicators for the diagnosis of cerebral ischemia and provide reliable evidence for early clinical treatment., Thereby preventing the occurrence of stroke.

关 键 词：急性Stanford A型主动脉夹层 头颅及体部CT血管造影 脑CT灌注成像 

分 类 号：R54[医药卫生—心血管疾病]