基于残余功能达峰时间的烟雾病联合血运重建术的脑血流动力学研究  

The study of cerebral hemodynamics in patients with moyamoya disease based on time to maximum of the residue function after combined revascularization surgery

作　　者：苏茹茹 欧阳颖 唐旭梅 杨万群 黄飚[1] SU Ru-ru;OU-YANG Ying;TANG Xu-mei(Department of Radiology,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China)

机构地区：[1]南方医科大学附属广东省人民医院(广东省医学科学院)放射科,广州510080

出　　处：《放射学实践》2025年第3期302-307,共6页Radiologic Practice

基　　金：国家自然科学基金面上项目(82071871)。

摘　　要：目的:探讨基于残余功能达峰时间(Tmax)在烟雾病联合血管重建术脑血流动力学评估及术后侧支循环改善情况的价值。方法:回顾性分析本院25例经联合血管重建术治疗的烟雾病患者,所有患者术前及术后近期(3~6个月)均行头颅CTP检查,收集患者的临床及影像资料。以人工智能(AI)为辅助,在CTP参数图(包括CBF、CBV、MTT和Tmax)上对术侧和对侧脑实质进行定量分析,并以脑干作为参照,获取其相对灌注参数值。采用多期相CTP原始图像评估搭桥血管通畅性及侧支循环评分;采用Spearman检验分析术前及术后rTmax变化与侧支循环改善情况及Tmax>4 s脑缺血体积变化的相关性。结果:相比于术前对侧脑实质,术侧脑实质rMTT和rTmax明显延长(P<0.05)。联合血运重建术治疗后,脑血流灌注有所改善,术侧脑组织rTmax较术前明显缩短(P<0.05)。Spearman相关性分析发现,术前、术后rTmax变化与Tmax>4 s脑缺血体积呈正相关(r=0.47,P<0.05),与侧支循环评分改善情况呈负相关(r=-0.40,P<0.05)。结论:AI辅助的CTP可便捷提供术前及术后血流动力学信息,Tmax是术后脑灌注变化的敏感指标,能反映烟雾病术后脑缺血体积及侧支循环改善情况。Objective:The purpose of this study was to explore the value of time to maximum of the residue function(Tmax)in the assessment of cerebral hemodynamics and the prediction of postoperative collateral circulation improvement in patients with moyamoya disease after combined revascularization surgery.Methods:A retrospective analysis was conducted on 25 patients with moyamoya disease treated with combined revascularization surgery in our hospital.All patients underwent CTP scanning before and shortly after(3 to 6 months)surgery,and clinical and imaging data were collected.Artificial intelligence(AI)was used as an auxiliary tool to perform quantitative analysis on the CTP parameter maps(including CBF,CBV,MTT and Tmax)of the operated and contralateral brain parenchyma,with the brainstem served as a reference to obtain relative perfusion parameter values.Multi-phase CTP was used to assess the patency of the bypass vessels and collateral circulation scores.Spearman's test was used to analyze the correlation between the changes in preoperative and postoperative rTmax and the changes in the volume of brain ischemia with Tmax>4s.Spearman's test was also used to analyze the correlation between the changes in preoperative and postoperative rTmax and the improvement of collateral circulation.Results:Compared with the contralateral brain parenchyma before surgery,the rMTT and rTmax of the operated brain parenchyma were significantly prolonged(P<0.05).After treatment with combined revascularization surgery,cerebral blood perfusion improved,and the rTmax of the operated brain tissue was significantly lower than before surgery(P<0.05).Spearman correlation analysis revealed that the changes in preoperative and postoperative rTmax were positively correlated with the volume of brain ischemia with Tmax>4s(r=0.47,P<0.05),and negatively correlated with the improvement of collateral circulation scores(r=-0.40,P<0.05).Conclusion:AI-assisted diagnosis of multi-phase CTP can conveniently provide preoperative and postoperative hemodynamic cha

关 键 词：烟雾病 联合血管重建术 CT灌注成像 相对残余功能达峰时间 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.4[医药卫生—诊断学]