CT脑灌注成像评估大脑中动脉重度狭窄或闭塞患者侧支循环建立及预后  

Evaluation of severe middle cerebral artery stenosis by CT perfusion establishment and prognosis of collateral circulation in patients with or occlusion

作　　者：郝璐[1] 陈欢[1] 徐敬轩[2] HAO Lu;CHEN Huan;XU Jingxuan(Department of Radiology,the Second Affiliated Hospital of Xinjiang Medical University,Urumqi 830063,China;Department of Neurosurgery,the Second Affiliated Hospital of Xinjiang Medical University,Urumqi 830063,China)

机构地区：[1]新疆医科大学第二附属医院影像科,新疆乌鲁木齐830063 [2]新疆医科大学第二附属医院神经外科,新疆乌鲁木齐830063

出　　处：《实用放射学杂志》2022年第6期880-883,共4页Journal of Practical Radiology

基　　金：新疆维吾尔自治区自然科学基金项目(2021D01C370)。

摘　　要：目的探讨CT脑灌注成像(CTP)对大脑中动脉(MCA)重度狭窄或闭塞患者侧支循环建立及预后的评估.方法收集经CT血管成像(CTA)证实单侧MCA重度狭窄或闭塞患者56例,基于多时相CTA对侧支血管进行分级,联合CTP发现缺血区域,利用半影分析成像测量无活力组织(NVT)与危及组织(TAR)的脑血容量(CBV)、脑血流(CBF)、平均通过时间(MTT)及达峰时间(TTP)等参数值,评估局部脑组织微循环状态与患者预后的相关性.结果侧支循环良好组NVT面积相对较小,TRA面积相对较大,NVT区2组间4个CTP参数差异无统计学意义(P>0.05);TRA区2组间CBV值差异无统计学意义(P>0.05),侧支循环良好组CBF较不良组增加,MTT、TTP明显缩短,且患者预后较好,差异均有统计学意义(P<0.05);侧支循环良好组入院时美国国立卫生研究院卒中量表(NIHSS)评分及经内科治疗7 d后NIHSS评分均低于侧支循环不良组.结论CTP可精准定位责任血管,直观显示TAR、NVT区域,对评价侧支循环及局部微循环状态有较高价值,为临床治疗及预后提供依据.Objective To investigate the evaluation of the establishment of collateral circulation and prognosis in patients with severe middle cerebral artery(MCA)stenosis or occlusion by CT perfusion(CTP).Methods Fifty-six patients with severe unilateral MCA stenosis or occlusion confirmed by CT angiography(CTA)were collected.The collateral vessels were graded based on multi temporal CTA,and the ischemic areas were found by CTP.The cerebral blood volume(CBV),cerebral blood flow(CBF),average transit time(MTT)and peak time(TTP)of non viable tissue(NVT)and tissue at risk(TAR)were measured by penumbral analysis imaging.The correlation between the microcirculation state of the local brain tissue and the patient's prognosis were assessed.Results The area of NVT in the good collateral circulation group was relatively small,and the area of TRA was relatively large.There was no significant difference in CTP parameters between the two groups in the NVT area(P>0.05);the difference in CBV value between the two groups in the TRA area had no statistically significance(P>>0.05),the CBF of the good collateral circulation group increased compared with the collateral circulatory dysfunction group,and MTT and TTP were significantly shortened.Also,the prognosis of the patients was better,the difference had statistically significance(P<0.05).The National Institutes of Health Stroke Scale(NIHSS)score at admission for the good collateral circulation group and NIHSS score after 7 days of medical treatment were lower than those in the collateral circulatory dysfunction group.Conclusion CTP can accurately locate the responsible blood vessels,visually and conveniently display the TAR and NVT areas,which is of high value for evaluating the state of collateral circulation and local microcirculation,and provides a basis for clinical treatment and prognosis.

关 键 词：灌注成像 大脑中动脉 侧支循环 预后 

分 类 号：R814.42[医药卫生—影像医学与核医学] R743[医药卫生—放射医学]