超声造影评估无症状性ICA重度狭窄患者CAS术后脑灌注改变的研究  

Evaluation of cerebral perfusion changes after CAS in patients with asymptomatic severe ICA stenosis by contrast-enhanced ultrasound

作　　者：程令刚[1] 康睿君 何文[1] 张巍[1] 张琳[1] CHENG Ling-gang;KANG Rui-jun;HE Wen;ZHANG Wei;ZHANG Lin(Department of Ultrasound,Beijing Tiantan Hospital,Capital Medical University,Beijing 100160,China)

机构地区：[1]首都医科大学附属北京天坛医院超声科,北京100160

出　　处：《中国临床医学影像杂志》2024年第8期533-536,共4页Journal of China Clinic Medical Imaging

基　　金：国家自然科学基金(81730050、82271995)。

摘　　要：目的:应用超声造影评估无症状性颈内动脉(ICA)重度狭窄患者行颈动脉支架置入术(CAS)后的脑灌注改变的价值。方法:选取2020年7月-2022年12月我院行CAS术的单侧ICA重度狭窄患者18例,男14例,女4例,平均年龄(62.6±7.3)岁。患者无临床症状或仅表现为轻度头痛、头晕。分别于CAS术前、术后12 h内行双侧经颅超声造影检查,选取基底节区作为感兴趣区(ROI)进行时间-强度曲线分析,测量参数为达峰时间(TTP),平均通过时间(MTT),上升斜率(WIS),峰值强度(PI),曲线下面积(AUC),计算患侧与健侧参数的相对值rTTP,rMTT,rWIS,rPI,rAUC,及CAS术后改变量ΔrTTP,ΔrMTT,Δr WIS,Δr PI,ΔrAUC。比较CAS术前、术后参数绝对值与相对值,并对CAS术前相对值与术后改变量的相关性进行分析。结果:CAS术前,患侧TTP(22.17±3.34) s,MTT (33.73±5.88) s均较健侧延长,WIS (1.75±0.68) dB/s低于健侧(P<0.05),而PI,AUC双侧比较无统计学差异;CAS术后,患侧参数绝对值仅WIS (2.14±0.69) dB/s较术前增高(P<0.05);相对值rTTP (1.02±0.08),r MTT(0.96±0.10)低于术前,rWIS (1.02±0.17)较术前增高(P<0.05);CAS术前相对值rTTP,rMTT,rWIS分别与术后改变量ΔrTTP,Δr MTT,ΔrWIS存在负相关关系(r值分别为-0.592,-0.754及-0.730)。结论:超声造影可评估无症状性ICA重度狭窄患者CAS术后脑灌注的改变,术后双侧灌注差异性降低,且患侧术前脑灌注受损程度越重,术后改善越明显。Objective:To evaluate cerebral perfusion changes after CAS in patients with asymptomatic severe internal carotid artery(ICA)stenosis by contrast-enhanced ultrasound.Methods:Eighteen patients(14 men,4 women;mean age 62.6±7.3 years)with unilateral severe ICA stenosis undergoing CAS from July 2020 to December 2022 were enrolled.All patients had no clinical symptoms or only mild headache and dizziness.Bilateral transcranial contrast-enhanced ultrasound were per-formed within 12 h before and after CAS.Basal ganglia was selected as the region of interest(ROI)for time-intensity curve analysis.Time to peak(TTP),mean transit time(MTT),wash-in slope(WIS),peak intensity(PI)and area under curve(AUC)were measured and the relative values based on the comparison between ipsilateral and contralateral side-rTTP,rMTT,rWIS,rPI,rAUC were calculated.Changes in relative values after CAS-ΔrTTP,ΔrMTT,ΔrWIS,ΔrPI,ΔrAUC were derived.The absolute and relative parameters prior and post to CAS were compared and the correlation analysis was done between relative values before CAS and the changes after CAS.Results:Before CAS,a delay of TTP(22.17±3.34)s and MTT(33.73±5.88)s as well as a lower value of WIS(1.75+0.68)dB/s were demonstrated on the ipsilateral side compared with the contralateral side(P<0.05),while no significant interhemispheric difference was found in PI and AUC.After CAS,only WIS(2.14±0.69)dB/s of the ipsilateral side was higher than the preprocedural value(P<0.05)among all absolute values.Relative values of rITP(1.02+0.08)and rMTT(0.96+0.10)were reduced and rWIS(1.02+0.17)was increased compared with values before CAS(P<0.05).Relative values of rTTP,rMTT and rWIS before CAS were negatively correlated with ΔrTTP,ΔrMTT and ΔrWIS,respectively(r=-0.592,-0.754 and-0.730,respectively).Conclusion:Contrast-enhanced ultrasound can evaluate the change of the cerebral perfusion of patients with asymptomatic severe ICA stenosis after CAS.The interhemispheric difference was reduced afer CAS.A stronger perfusion impairment of the i

关 键 词：颈动脉狭窄 超声检查 多普勒 彩色 

分 类 号：R543.3[医药卫生—心血管疾病] R445.1[医药卫生—内科学]