低剂量CTA联合CTP在动脉瘤性SAH的应用时效性  

Timeliness of the application of low-dose CTA combined with CTP in the application of aneurysmal subarachnoid hemorrhage

作　　者：罗伟[1] 姚景江 张亚林 贺素军 LUO Wei;YAO Jingjiang;ZHANG Yalin;HE Sujun(Department of Radiology,Changsha Central Hospital,University of South China,Changsha 4100004,China)

机构地区：[1]南华大学附属长沙中心医院放射科,湖南长沙410004

出　　处：《医学影像学杂志》2023年第2期186-191,共6页Journal of Medical Imaging

基　　金：湖南省卫生健康委科研计划项目(编号:20201990)。

摘　　要：目的 探讨低剂量CTA联合CTP在不伴有脑血管痉挛的动脉瘤性蛛网膜下腔出血(SAH)的应用时效性。方法 选取85例SAH患者随机分为A组(42例,管电压120 kV)、B组(43例,管电压80 kV),比较两组大脑中动脉CT值、信噪比(SNR)、对比噪声比(CNR)、剂量长度乘积(DLP)、有效辐射剂量(ED)、图像质量。发病后4~7天复查,选取这2次检查均显示脑血管痉挛(CVS)阴性者分为DCI组和N-DCI组,比较两组患者发病当日及发病后4~7天的CTP各定量参数。结果 A、B两组间的CT值、SNR、CNR、CTA及CTP的图像主观质量评价差异均无统计学意义(P>0.05),两组间ED值差异有统计学意义(P<0.05)。SAH发病当日DCI组及N-DCI组TTP值差异有统计学意义(P<0.05),MTT、CBF、CBV值差异无统计学意义(P>0.05);SAH发病后4~7天DCI组及N-DCI组的CTP各灌注参数差异有统计学意义(P<0.05)。MTT、TTP值在发病当天、第4~7天比较差异无统计学意义(P>0.05),CBV、CBF值前后两次比较差异有统计学意义(P<0.05)。结论 低剂量CTA联合CTP可实现动脉瘤性SAH动脉形态学与脑灌注功能的综合评估。SAH发病当日CTP检查预测DCI效能不佳,SAH发病后4~7天CTP检查能较准确预测DCI。Objective To explore the time-efficiency of low-dose CTA combined with CTP in the application of aneurysmal SAH without cerebral vasospasm. Methods 85 SAH patients were randomly divided into group A(42 cases, tube voltage 120 kV) and group B(43 cases, tube voltage 80 kV). The CT values, signal-to-noise ratio(SNR), and contrast-to-noise ratio(CNR), dose length product(DLP), effective radiation dose(ED), image quality of the middle cerebral artery were compared between the two groups. Re-examination was performed 4~7 days after the onset of the disease. Those who were negative for CVS in these 2 tests were divided into the DCI group and the N-DCI group. The quantitative parameters of CTP on the day of onset and 4~7 days after the onset of the two groups were compared. Results There were no statistically significant differences in the subjective quality evaluation of images in CT value, signal-to-noise ratio, contrast-to-noise ratio, the subjective quality evaluation of CTA and CTP images between groups A and B(P>0.05), while group B of the tube voltage group was lower than that of the group A, and the difference between the two groups was statistically significant(P<0.05). On the day of SAH onset, the TTP values of the DCI group and the N-DCI group were different(P<0.05), which showed that the TTP value of the DCI group was slightly prolonged, but there was no significant difference in the MTT, CBF and CBV values between the two groups(P>0.05);4~7 days after the onset of SAH, the CTP perfusion parameters of the DCI group and the N-DCI group had significant differences(P<0.05), which was manifested as the increase of the TTP and MTT values in the DCI group, and the decrease of the CBF and CBV values. The values of MTT and TTP had no difference between groups on the day of onset and 4~7 days of onset, while the values of CBV and CBF were different on the day of onset and 4~7 days of onset. Conclusion Low-dose CTA combined with CTP can achieve a comprehensive assessment of the arterial morphology and cerebral perfusio

关 键 词：蛛网膜下腔出血 低辐射剂量 迟发性脑缺血 体层摄影术 X线计算机 

分 类 号：R743.35[医药卫生—神经病学与精神病学] R814.42[医药卫生—临床医学]