CT灌注对不同血管重建术式治疗成人缺血型烟雾病疗效评估的价值  

Value of CT perfusion in evaluating the efficacy of different vascular reconstruction methods in the treatment of adult ischemic moyamoya disease

作　　者：袁雪霞[1] 薛晓丽 李美芹[1] 付林 李昕 刘德国 陈月芹[1] 宋国红[3] Yuan Xuexia;Xue Xiaoli;Li Meiqin;Fu Lin;Li Xin;Liu Deguo;Chen Yueqin;Song Guohong(Department of Medical Imaging,Affiliated Hospital of Jining Medical University,Jining 272029,China;Clinical School,Jining Medical University,Jining 272013,China;Department of Neurosurgery,Affiliated Hospital of Jining Medical University,Jining 272029,China)

机构地区：[1]济宁医学院附属医院医学影像科,济宁272029 [2]济宁医学院临床学院,济宁272013 [3]济宁医学院附属医院神经外科,济宁272029

出　　处：《中国医师杂志》2025年第2期189-194,共6页Journal of Chinese Physician

基　　金：山东省自然科学基金(ZR2021MH109);济宁市重点研发计划项目(2022YXNS060);济宁医学院附属医院主诊医师团队专项临床研究计划项目(ZZTD-MS-2023-05)。

摘　　要：目的探讨CT灌注(CTP)对不同血管重建术式治疗成人缺血型烟雾病临床疗效评估的价值。方法回顾分析2019年2月—2023年2月在济宁医学院附属医院接受血管重建术治疗的80例成人缺血型烟雾病患者的临床资料,其中接受颞浅动脉-大脑中动脉吻合术(直接组)者43例,接受脑-硬脑膜-动脉血管融通术(间接组)者37例,比较两组患者临床症状改善情况、改良Rankin量表(mRS)评分、侧支血管情况及CTP各参数差异。结果直接组临床症状改善情况优于间接组(P<0.05),明显缓解率也显著高于间接组[86.0%(37/43)vs 59.5%(22/37),χ^(2)=7.262,P=0.007]。直接组术后mRS评分较术前明显降低[0(0,1)vs 1(1,2),Z=5.550,P<0.001],间接组术后mRS评分较术前明显降低[0(0,1)vs 1(1,2),Z=4.281,P<0.001],但两组术后mRS评分比较差异无统计学意义(P>0.05)。两组术后DSA侧支血管形成情况比较差异无统计学意义(P>0.05)。两组手术前、后CTP参数值观察者间和观察者内部均具有较好的一致性(ICC范围0.88~0.94)。在手术区,两组术后相对脑血流量(rCBF)均较术前显著增高,相对达峰时间(rTTP)及相对平均通过时间(rMTT)均显著减低,差异均有统计学意义(均P<0.05);在同侧基底节及额叶,直接组术后rCBF均较术前显著增高,rTTP及rMTT均显著减低,差异均有统计学意义(均P<0.05),而间接组各参数差异均无统计学意义(均P>0.05)。直接组手术区rCBF、rTTP及rMTT变化值优于间接组,基底节rCBF、rTTP变化值及额叶rCBF变化值均优于间接组,差异均有统计学意义(均P<0.05),余参数比较差异均无统计学意义(均P>0.05)。结论CT灌注在评估不同血管重建术式治疗成人缺血型烟雾病临床症状改善差异中具有重要价值。ObjectiveTo evaluate value of CT perfusion in evaluating the efficacy of different vascular reconstruction methods in the treatment of adult ischemic moyamoya disease.MethodsThe clinical data of 80 adult patients with moyamoya disease with ischemic blood type who received revascularization in the Affiliated Hospital of Jining Medical University from February 2019 to February 2023 were retrospectively analyzed,including 43 patients who received superficial temporal arterio-middle cerebral artery anastomosis(direct group)and 37 patients who received brain-dural arterio-artery vascularization(indirect group).The improvement of clinical symptoms,Modified Rankin Scale(mRS)Score,collateral vessels and CTP parameters were compared between the two groups.ResultsThe improvement of clinical symptoms in the direct group was better than that in the indirect group(P<0.05),and the significant remission rate was significantly higher than that in the indirect group[86.0%(37/43)vs 59.5%(22/37),χ^(2)=7.262,P=0.007].The postoperative mRS score in the direct group was significantly lower than that before surgery[0(0,1)vs 1(1,2),Z=5.550,P<0.001].The score of mRS After surgery in the indirect group was significantly lower than that before surgery[0(0,1)vs 1(1,2),Z=4.281,P<0.001],but there was no statistically significant difference between the two groups(P>0.05).There was no significant difference in digital subtraction angiography(DSA)collateral vessel formation between the two groups(P>0.05).The CTP parameters of the two groups before and after surgery were consistent between observers and within observers[intraclass correlation coefficient(ICC)range 0.88-0.94].In the operation area,the relative cerebral blood flow(rCBF)after surgery was significantly increased,and the relative time to peak(rTTP)and relative mean transit time(rMTT)were significantly decreased in both groups,with statistical significance(P<0.05).In the ipsilateral basal ganglia and frontal lobe,rCBF in the direct group was significantly increased,rTTP and rMTT were

关 键 词：脑血管重建术 烟雾病 灌注成像 

分 类 号：R74[医药卫生—神经病学与精神病学]