脑动脉瘤夹闭术后脑动脉痉挛的CT灌注研究  

The Study of CTP in the Diagnosis of Cerebral Ischemia on Account of Vasospasm in Patients with Intracranial Aneurysm Clipping

作　　者：冯其金 林成灿 郑真得 苏泉荣 庄菲菲 张帆[1] 陈瑞权[1] Feng Qijin;Lin Chengcan;Zheng Zhende;Su Quanrong;Zhuang Feifei;Zhang Fan;Chen Ruiquan(Department of Medical Imaging,The First Affiliated Hospital of Fujian MedicalUniversity,Fuzhou,Fujian 350005)

机构地区：[1]福建医科大学附属第一医院医学影像科,福建福州350005

出　　处：《现代医用影像学》2021年第9期1591-1595,共5页Modern Medical Imageology

摘　　要：目的:研究CT灌注(computed tomography perfusion,CTP)检查在评估脑动脉瘤夹闭术后脑动脉痉挛所致脑缺血中的价值。方法:对314例脑动脉瘤夹闭术后患者进行筛选,回顾性分析63例脑动脉瘤夹闭术前、术后脑CT血管成像(computed tomography angiography)CTA/CTP原始图像及后处理图像,利用CTP检查数据重建脑CTA图像,对比术前、术后减影脑动脉CTA图像,术后动脉管径变小后恢复诊断动脉痉挛。脑少血判定方法:患侧rCBV、rCBF与对侧对称或增高,MTT和或TTP延迟;脑缺血判定方法:患侧rCBV和或rCBF较对侧降低,MTT和TTP延迟。测量脑灌注异常患者血管痉挛前后管径大小,应用Pearson相关性分析动脉痉挛程度与脑灌注不足程度的关系。结果:63例脑动脉瘤夹闭术后患者存在血管痉挛,23例为局限性动脉痉挛:其中脑灌注正常2例、脑少血9例、脑缺血12例(其中3例脑梗死)。统计学分析得出脑灌注程度与动脉痉挛程度无相关性。结论:CTP检查可很好的判断动脉瘤夹闭术后是否存在动脉痉挛导致的脑缺血,有助于临床医师制定术后治疗计划,从而有望改善患者预后,建议动脉瘤夹闭术后患者常规行CTP检查。Objective:To explore the value of CTP in the diagnosis of cerebral ischemia on account of vasospasm in patients with intracranial aneurysm clipping.Materials and Methods:314 patients with intracranial aneurysm clipping were screened,63 patients were enrolled.All patients underwent CTP study before and after clipping,reconstruction CTA images by adopting the data of CTP.Diagnostic criteria of artery vasospasm was established when there was a recover lumen after decreased caliber of artery by comparing the pre-and post-operative subtraction images.By comparing with the contralateral side,diagnostic criteria of insufficient perfusion was established if pathologic region’s MTT or TTP was delay,while rCBV or rCBF remain the same,diagnostic criteria of ischemia was established if pathologic region’s CBF or CBV was decline and MTT or TTP was delay.The diameter of the spasmodic arteries was measured before and after operation with abnormal cerebral perfusion.Pearson’s product-moment correlation analysis was used to evaluate the relationship between the degree of vasospasm and the severity of insufficient cerebral perfusion.R esults:63 patients were revealed artery vasospasm,23 with regional cerebral artery vasospasm.Among 23 patients,normal CTP was present in 2,abnormal CTP in remaining 21,including 9 with insufficient perfusion,12 with ischemia(3 with infarct).No significant relationship between the degree of artery vasospasm and the severity of insufficient cerebral perfusion was demonstrated statistically.Conclusion:CTP is the imaging modality of choice in detecting cerebral artery vasospasm after cerebral aneurysm clipping and subsequent cerebral ischemia,helping clinical doctors establish treatment plan and improving outcomes.

关 键 词：脑动脉瘤夹闭术后 动脉痉挛 体层摄影术 X线计算机 灌注 

分 类 号：R651.12[医药卫生—外科学]