脑CT灌注成像与CT血管成像诊断颈内动脉狭窄及闭塞的临床研究  

The application study of CT perfusion and CT subtraction angiography in the stenosis and obstruction of internal carotid artery

作　　者：刘翔[1] 戴建平[2] 詹炯[2] 孙波[2] 

机构地区：[1]首都医科大学 [2]北京市神经外科研究所神经影像室,100050

出　　处：《中华放射学杂志》2003年第8期732-736,共5页Chinese Journal of Radiology

摘　　要：目的　评价CT灌注成像与CT血管成像 (CTA)在颈内动脉狭窄及闭塞疾病中的临床应用价值。方法　 2 7例颈内动脉狭窄及闭塞的患者 ,14例行单层CT灌注成像 ,对比剂总量为 50ml ,注射流率为 4.5ml s。 13例行 2次CT灌注成像 ,每次对比剂剂量为 3 5ml。随后使用螺旋CT扫描对颈内动脉颅外段和 (或 )颅内段行CTA。由 2名神经影像医生阅片比较 2种CT灌注成像的最大峰值时间 (timetopeak ,PT) ,以及平均通过时间 (meantransittime ,MTT)和相对血流量 (relativeflow ,RF)图像。观察CT血管成像的螺旋横轴面图像以评价管壁斑块。应用Xtension软件实现最大密度投影(maximumintensityprojection ,MIP)和表面阴影成像 (thresholdshadedsurfacedisplay ,SSD)以观察血管整体形态 ;使用FlyThrough软件生成CT仿真血管内窥镜图像以观察血管内部形态。结果　 2 7例患者常规CT图像检出 2 9个病灶。CT灌注图像共检出 43个病灶 ,其中 8个病灶RF与对侧相比无明显降低 ;其MTT略延长 ,PT明显延长。注射 3 5ml对比剂与注射 50ml对比剂的CT灌注图像的质量差异无显著性意义 (χ2 =0 .487,P >0 .0 5)。 13例患者 2 6支颈动脉中 2 1支颈动脉可以观察到动脉管壁钙化斑块 ,15支颈动脉可以观察到密度值为 -12～ 15HU的软斑块。SSD。Objective To evaluate the clin ical application of CT perfusion imaging and CT angiograhy in internal carotid artery occlusive disease. Methods Twenty-seven patients with internal carotid artery occlusion or stenosis were confirmed by DSA or MRA. 14 patients were performed with single slice CT perfusion imaging with the contrast material dosage of 50 ml and the injection rate of 4.5 ml/s. 13 patients were performed with two slices CT perfusion imaging with the dose of 35 ml for each slice. Then CT angiogaphy of internal carotid artery was performed. The time to peak (PT), mean transit time (MTT), and relative flow (RF) acquired by the two imaging methods were compared by two experienced neuroradiologists, respectively. The CT angiography images including source axial images and reconstructed images by MIP, SSD, and Fly Through method were also analyzed. Results CT perfusion imaging detects more and larger ischemic lesions than regular CT images including 8 lesions with normal RF, prolonged MTT and PT. There were no significant difference between two CT perfusion imaging methods, P >0.05 by χ 2 test (χ 2=0.487). CT angiography of SSD, MIP, and CT virtual vascular endoscopy could show the location, extent and degree of occlusion or stenosis of internal carotid arteries clearly. CT angiography could also detect calcific plaque in 21 internal carotid arteries and soft plaque in 15 internal carotid arteries. Conclusion Two slices CT perfusion imaging could be made with regular helical CT scanner. CTA could also evaluate the status of plaque. The combination of CT perfusion imaging and CTA are useful not only in observing the morphology of internal carotid arteries, but also in observing the hemodynamic information of the brain, which are important for further general individual analysis.

关 键 词：脑CT灌注成像 CT血管成像 诊断 颈内动脉狭窄 颈内动脉闭塞 血液动力学 脑血管造影术 

分 类 号：R816.1[医药卫生—放射医学]