基于低辐射剂量全脑CT灌注评估急性缺血性脑卒中侧支循环的研究  

Collateral circulation assessment in acute ischemic stroke based on low dose whole brain CT perfusion

作　　者：王雁南 周俊林[1,2] 那飞扬 刘显旺 刘建莉 WANG Yannan;ZHOU Junlin;NA Feiyang;LIU Xianwang;LIU Jianli(Department of Radiology,Lanzhou University Second Hospital,Lanzhou 730000,China;Key Laboratory of Medical Imaging in Gansu Province,Lanzhou 730000,China;Allergy Department,Gansu Provincial Maternity and Child-care Hospital,Lanzhou 730000,China)

机构地区：[1]兰州大学第二医院放射科,甘肃兰州730000 [2]甘肃省医学影像重点实验室,甘肃兰州730000 [3]甘肃省妇幼保健院过敏反应科,甘肃兰州730000

出　　处：《中国医学物理学杂志》2023年第8期950-956,共7页Chinese Journal of Medical Physics

基　　金：国家自然科学基金(82071872);甘肃省自然科学基金(22JR5RA996)。

摘　　要：目的:探讨低剂量全脑CT灌注(CTP)容积数据重建的优化多期CTA(omCTA)对急性缺血性脑卒中患者侧支循环评估的临床应用价值。方法:选取2019年10月至2021年10月于兰州大学第二医院脑卒中中心以缺血性脑卒中收治住院,且诊断为单侧大脑中动脉闭塞的患者56例。所有患者入院后均行多模式CT(头颅平扫+全脑CTP+头颈CTA)检查。利用CTP原始数据采用不同权重的后置ASiR-V算法重建omCTA图像,比较40%、60%、80%权重的后置ASiR-V算法重建omCTA与常规CTA血管强化CT值、信噪比(SNR)、对比噪声比(CNR)、主观图像质量及侧支循环评分。结果:低剂量全脑CTP有效辐射剂量为(2.27±0.10)mSv,多模式CT扫描总辐射剂量(3.21±0.17)mSv;40%、60%、80%后置ASiR-V算法重建的omCTA的动脉强化CT值差异无统计学意义(P>0.05),omCTA组的血管强化CT值均高于CTA组(P<0.05);omCTA组与CTA组的SNR、CNR差异均无统计学意义(P>0.05);omCTA组中60%权重的ASiR-V算法重建的omCTA图像在动脉强化及静脉污染方面优于CTA组(P<0.05);omCTA 3组图像噪声均低于CTA组,其中omCTA组中60%权重的ASiR-V算法重建图像噪声最小。结论:基于低辐射剂量全脑CT灌注的omCTA图像质量能满足临床需求,能全面评估急性缺血性脑卒中患者侧支循环状态。Objective To investigate the role of optimized multiphase CT angiography(omCTA)based on volume reconstruction using low dose whole brain CT perfusion(CTP)data in the assessment of collateral circulation in patients with acute ischemic stroke.Methods A total of 56 patients with ischemic stroke who were diagnosed as having unilateral middle cerebral artery occlusion were admitted to Stroke Center of Lanzhou University Second Hospital from October 2019 to October 2021.After admission,all patients underwent multimodality CT(head plain scan+whole brain CTP+head and neck CTA)examination.The CTP original data and ASiR-V algorithms with different weights(40%,60%and 80%)were used to reconstruct omCTA images.The CT number of vascular enhancement,signal-to-noise ratio,contrast-to-noise ratio,subjective image quality and collateral circulation score were compared between omCTA groups and CTA group.Results The effective radiation dose of low dose whole brain CTP was(2.27±0.10)mSv,and the total radiation dose of multimodality CT scan was(3.21±0.17)mSv.There was no significant difference in the CT number of arterial enhancement among omCTA3 groups with 40%,60%and 80%ASiR-V.The CT number of vascular enhancement in omCTA groups was higher than that in CTA group(P<0.05).The differences in signal-to-noise ratio and contrast-to-noise ratio between omCTA groups and CTA group were trivial(P>0.05).The omCTA images reconstructed with 60%ASIR-V in omCTA group were superior to those reconstructed in CTA group in arterial enhancement and venous contamination(P<0.05).The image noises in omCTA groups were lower than those in CTA group,and the omCTA group with 60%ASir-V has the least noise.Conclusion The omCTA image obtained based on low dose CTP can be used to comprehensively assess collateral circulation status in patients with acute ischemic stroke.

关 键 词：低剂量CT全脑灌注 脑卒中 侧支循环 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]