CT脑灌注成像对单侧颈动脉狭窄患者血流动力学及侧支循环状态的评估价值  

Evaluation of Hemodynamics and Collateral Circulation in Patients with Unilateral Carotid Artery Stenosis by CT Cerebral Perfusion Imaging

作　　者：刘石琳 彭栋 王霞[1] 汪露[1] 路英 Liu Shilin;Peng Dong;Wang Xia(Physical Examination and Health Management,Interventional,Ultrasound Diagnosis Room,Laboratory,Department of the Second Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830018,China)

机构地区：[1]新疆医科大学第二附属医院体检与健康管理科,介入科,超声诊断室,检验科,新疆乌鲁木齐830018

出　　处：《四川医学》2025年第3期290-295,共6页Sichuan Medical Journal

基　　金：新疆神经系统疾病研究重点实验室项目(编号:XJDX1711-2111)。

摘　　要：目的CT脑灌注成像(CTP)对单侧颈动脉狭窄患者血流动力学及侧支循环状态的评估价值。方法选取2021年7月至2022年6月我院收治的186例单侧颈动脉狭窄体检及住院患者,根据颈动脉狭窄程度分为轻度狭窄组(n=88)、中度狭窄组(n=68)、重度或闭塞组(n=30),根据侧支循环代偿情况分为侧支循环好组(n=122)和侧支循环差组(n=64);比较不同狭窄程度组和不同侧支循环组患者的CTP成像定量参数[相对脑血容量(rCBV)、相对脑血流量(rCBF)、相对平均通过时间(rMTT)、相对达峰时间(rTTP)];分析CTP参数与颈动脉狭窄程度及侧支循环评分的相关性;绘制受试者工作特征(ROC)曲线评估CTP定量参数对侧支循环代偿情况的诊断价值。结果单侧颈动脉不同狭窄程度患者rCBF比较,差异无统计学意义(P>0.05)。rMTT、rTTP随狭窄程度增加而升高(P<0.05);与轻度狭窄组比较,重度或闭塞组rCBV降低(P<0.05)。与侧支循环好组比较,侧支循环差组患者rCBV较低,rMTT、rTTP较高(P<0.05)。相关性分析显示,rTTP、rMTT与颈动脉狭窄程度呈正相关(P<0.05);rCBV与侧支循环评分呈正相关,rTTP、rMTT与侧支循环评分呈负相关(P<0.05)。ROC曲线分析结果显示,rCBV、rCBF、rTTP、rMTT诊断无侧支循环的曲线下面积(AUC)分别为0.598(95%CI 0.509~0.680)、0.593(95%CI 0.505~0.679)、0.785(95%CI 0.706~0.851)、0.861(95%CI 0.790~0.916),rTTP、rMTT诊断效能较rCBV、rCBF更高(P<0.05)。结论CTP成像定量参数可用于监测单侧颈动脉狭窄患者血流动力学受损及侧支循环状态,且rTTP、rMTT是诊断侧支循环较差的敏感指标。Objective To evaluate the hemodynamics and collateral circulation status of patients with unilateral carotid artery stenosis by CT cerebral perfusion(CTP)imaging.Methods 186 patients with unilateral carotid artery stenosis admitted to our hospital from July 2021 to June 2022 were selected.According to the degree of carotid artery stenosis,the patients were divided into mild stenosis group(n=88),moderate stenosis group(n=68),severe or occlusive group(n=30),good collateral circulation group(n=122)and poor collateral circulation group(n=64)according to the compensation of collateral circulation.The CTP imaging quantitative parameters in different stenosis degree and collateral circulation group were compared,including relative cerebral blood volume(rCBV),relative cerebral blood flow(rCBF),relative mean transit time(rMTT),relative peak time(rTTP).The correlation between CTP parameters and the degree of carotid artery stenosis and collateral circulation score was analyzed.Receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of CTP quantitative parameters on collateral circulation compensation.Results There was no significant difference in rCBF among patients with different degree of unilateral carotid artery stenosis(P>0.05).rMTT and rTTP increased with the degree of stenosis(P<0.05).rCBV in severe/occlusivity group was lower than that of mild stenosis group(P<0.05).Compared with the good collateral circulation group,the rCBV of the poor collateral circulation group was lower,and the rMTT and rTTP were higher(P<0.05).Correlation analysis showed that rTTP and rMTT were positively correlated with carotid artery stenosis(P<0.05).rCBV was positively correlated with collateral cycle score,while rTTP and rMTT were negatively correlated with collateral cycle score(P<0.05).ROC curve analysis results showed that the area under the curve(AUC)of rCBV,rCBF,rTTP and rMTT diagnosis without lateral circulation were 0.598(95%CI 0.509~0.680),0.593(95%CI 0.505~0.679),0.785(95%CI 0.706~0.851),0.861(95%C

关 键 词：颈动脉狭窄 CT脑灌注成像 血流动力学 侧支循环 

分 类 号：R743.4[医药卫生—神经病学与精神病学]