脑梗死后交叉性小脑神经机能联系不能与运动损伤的全脑CTP研究  

Evaluate CCD and Motor Impairment after Cerebral Infarction by Whole Brain CTP

作　　者：晁慧美 翟功用 蒋思佳 赵秋枫 潘露茜[1,2] 王嵩[1,2] CHAO Huimei;ZHAI Gongyong;JIANG Sijia(Shanghai University of Traditional Chinese Medicine,Shanghai 201203,P.R.China)

机构地区：[1]上海中医药大学,201203 [2]上海中医药大学附属龙华医院,200032

出　　处：《临床放射学杂志》2024年第5期710-714,共5页Journal of Clinical Radiology

基　　金：龙华医院科技创新项目(编号:KY22051)。

摘　　要：目的 运用全脑CT灌注成像(CTP)评估交叉性小脑神经机能联系不能(CCD),探讨CTP的应用价值及脑梗死后CCD与运动损伤的关系。方法 搜集急性及亚急性期单侧幕上新发脑梗死病例115例为实验组,同时期正常志愿者10名为对照组,均在症状稳定期行320排CT全脑灌注扫描,并对实验组评估运动受损等级。结果实验组有45例发生CCD,对照组两侧小脑半球灌注值无统计学差异(P>0.05)。急性期脑梗死组,肌力评分在3级以上者CCD发生率为21.9%;在1~3级者CCD发生率为55%;0级者CCD发生率为66.7%。亚急性期脑梗死组,肌力评分在3级以上者CCD发生率为35.1%;在1~3级者CCD发生率为50%;0级者CCD发生率为100%。亚急性期CCD阳性组肌力评分低于CCD阴性组,差异具有统计学意义(P<0.05)。急性期CCD阳性组小脑达峰时间变化率(ΔTTP)、平均通过时间变化率(ΔMTT)与肌力评分呈负相关(P<0.05),亚急性期CCD阳性组小脑ΔTTP、ΔMTT、脑血流量(CBF)减低率与肌力评分呈负相关(P<0.05)。结论 全脑CTP能有效评估脑梗死后CCD。CCD更易发生在运动损伤严重的患者,小脑不对称指数与运动损伤程度关系密切。Objective To evaluate the relationship between motor deficits and crossed cerebellar diaschisis(CCD) after cerebral infarction using 320-slice CT whole-brain perfusion imaging. Methods A total of 115 patients with acute and subacute unilateral supratentorial cerebral infarction confirmed by MRI were enrolled as the experimental group, and 10 normal volunteers were enrolled as the control group. All patients underwent CT whole brain perfusion scan during the stable phase of symptoms, and the motor impairment grade was evaluated in the experimental group. Results CCD occurred in 45 cases in the experimental group, and there was no significant difference in the perfusion value of bilateral cerebellar hemispheres in the control group(P>0.05).In the acute cerebral infarction group, the incidence of CCD in patients with muscle strength score above grade 3 was 21.9%.The incidence of CCD in patients with grade 1-3 was 55%.The incidence of CCD in grade 0 patients was 66.7%.In subacute cerebral infarction group, the incidence of CCD was 35.1% in patients with muscle strength score above grade 3.The incidence of CCD was 50% in the cases between 1 and 3.The incidence of CCD in grade 0 patients was 100%.The muscle strength score of CCD-positive group was lower than that of CCD-negative group in subacute stag(P<0.05).ΔTTP and ΔMTT in the cerebellum were negatively correlated with the muscle strength score in the CCD-positive group at acute stage, and the reduction rates of ΔTTP,ΔMTT and CBF in the cerebellum in the CCD-positive group at subacute stage were negatively correlated with the muscle strength score. Conclusion 320-slice CT whole-brain perfusion scan can effectively evaluate CCD after cerebral infarction. CCD is more likely to occur in patients with severe motor impairment after cerebral infarction. Cerebellar asymmetry index is related to the degree of motor impairment.

关 键 词：脑梗死 脑灌注 交叉性小脑神经机能联系不能 运动损伤 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]