MSCTA联合CTPI对脑动脉狭窄/闭塞后侧支循环的评价
|
摘要
目的探讨多层螺旋CT血管成像(MSCTA)联合脑CT灌注成像(CTPI)对脑动脉狭窄/闭塞后侧支循环的评价。方法对临床拟诊为动脉粥样硬化性脑动脉狭窄的脑缺血性疾病患者行MSCTA及CTPI检查。根据纳入、排除标准共67例患者入组,以MSCTA为标准对侧支循环进行分类评估。记录CTPI图像中的脑灌注异常区域,测量病变脑区及对侧镜像脑区的灌注参数。评价不同侧支循环类型对脑灌注参数的影响。结果不同侧支循环类型患者的脑血容量(CBV)数据组间无统计学差异(P>0.05),但原发侧支循环组CBV高于其他各组。脑血流量(CBF)、平均通过时间(MTT)的组间比较存在统计学差异(P<0.05)。结论原发侧支循环在保护脑组织方面起到了至关重要的作用。通过评价侧支循环的代偿作用,可以为临床早期干预治疗及预后的判断提供有力的证据。
Objective To study the clinical value of the combined use of multi-slice CT angiography(MSCTA) and CT perfusion imaging(CTPI) for evaluation of the establishment of collateral circulation after cerebral artery stenosis and occlusion. Methods Patients who had clinical suspicion of chronic cerebral artery stenosis from atherosclerosis underwent MSCTA and CTPI. Cases were selected according to the inclusion and exclusion criteria,and were evaluated based on MSCTA. The consistency of the two techniques in diagnosing cerebral artery stenosis/occlusion and collateral circulation were compared. Areas of abnormal cerebral perfusion in CTPI images were recorded. Parameters of perfusion of diseased areas and those of their other sides were recorded,including CBF,CBV,and MTT,etc. The effects of different types of collateral circulation on cerebral perfusion parameters were evaluated. Results The differences of CBV among groups of patients with different types of collateral circulation are not statistically significant(P>0.05),but the CBV of primary collateral circulation is larger than other groups. The differences of CBF and MTT among the groups, are however of statistical significance(P<0.05). Conclusion Primary collateral circulation plays a vital role in protecting brain tissues. Through evaluation of compensatory effects of collateral circulation,a valuable proof for early clinical intervention and prognosis might be put forward.
Objective To study the clinical value of the combined use of multi-slice CT angiography(MSCTA) and CT perfusion imaging(CTPI) for evaluation of the establishment of collateral circulation after cerebral artery stenosis and occlusion. Methods Patients who had clinical suspicion of chronic cerebral artery stenosis from atherosclerosis underwent MSCTA and CTPI. Cases were selected according to the inclusion and exclusion criteria,and were evaluated based on MSCTA. The consistency of the two techniques in diagnosing cerebral artery stenosis/occlusion and collateral circulation were compared. Areas of abnormal cerebral perfusion in CTPI images were recorded. Parameters of perfusion of diseased areas and those of their other sides were recorded,including CBF,CBV,and MTT,etc. The effects of different types of collateral circulation on cerebral perfusion parameters were evaluated. Results The differences of CBV among groups of patients with different types of collateral circulation are not statistically significant(P>0.05),but the CBV of primary collateral circulation is larger than other groups. The differences of CBF and MTT among the groups, are however of statistical significance(P<0.05). Conclusion Primary collateral circulation plays a vital role in protecting brain tissues. Through evaluation of compensatory effects of collateral circulation,a valuable proof for early clinical intervention and prognosis might be put forward.
引文
1 Johnston SC,Mendis S,Mathers CD.Global variation in stroke burden and mortality:estimates from monitoring,surveillance,and modeling [J].Lancet Neurol,2009,8:345-354.
2 胡善联,龚向光.中国缺血性脑卒中的疾病经济负担[J].中国卫生经济,2011,27:1183-1187.
3 Liu L,Wang D,Wong KS,et al.Stroke and stroke care in China:huge burden,significant workload,and a national priority[J].Stroke,2011,42:3651-3654.
4 Menon BK,Qazi E,Nambiar V,et al.Differential effect of baseline computed tomographic angiography collaterals on clinical outcome in patients enrolled in the Interventional Management of Stroke III trial[J].Stroke,2015,46:1239-1244.
5 Liebeskind DS.Collateral circulation[J].Stroke,2003,34:2279-2284.
6 Wolfgang S.Collateral circulation[J].Basic Research in Cardiology,2003,34:2279-2284..
7 Manning NW,Campbell BCV,Oxley TJ,et al.AIS:Time,Penumbra and Reperfusion[J].Stroke,2014,45:640-644.
8 Addis KA,Hopper KD,Iyriboz TA,et al.CT angiography:in vitro comparison of five reconstruction methods [J].AJNR,2001,177:1171-1176.
9 Konig M.Brain perfusion CT in acute stroke,current status[J].Eur Radiol,2003,45:11-22.
10 高培毅,林燕.脑梗死前期脑局部低灌注的灌注成像表现及分期[J].中枢神经系统放射学,2003,37:882-886.
11 Jongen LM,Van der worp HB,Waaijer A,et al.Interrelation between the degree of carotid stenosis,collateral circulation and cerebral perfusion[J].Cerebrovasc Dis,2010,30:277-284.
12 叶长安.脑梗塞前期患者的脑血流动力学的改变及多排灌注成像表现及分期[J].中国和杂志,2015,12:42-44.
2 胡善联,龚向光.中国缺血性脑卒中的疾病经济负担[J].中国卫生经济,2011,27:1183-1187.
3 Liu L,Wang D,Wong KS,et al.Stroke and stroke care in China:huge burden,significant workload,and a national priority[J].Stroke,2011,42:3651-3654.
4 Menon BK,Qazi E,Nambiar V,et al.Differential effect of baseline computed tomographic angiography collaterals on clinical outcome in patients enrolled in the Interventional Management of Stroke III trial[J].Stroke,2015,46:1239-1244.
5 Liebeskind DS.Collateral circulation[J].Stroke,2003,34:2279-2284.
6 Wolfgang S.Collateral circulation[J].Basic Research in Cardiology,2003,34:2279-2284..
7 Manning NW,Campbell BCV,Oxley TJ,et al.AIS:Time,Penumbra and Reperfusion[J].Stroke,2014,45:640-644.
8 Addis KA,Hopper KD,Iyriboz TA,et al.CT angiography:in vitro comparison of five reconstruction methods [J].AJNR,2001,177:1171-1176.
9 Konig M.Brain perfusion CT in acute stroke,current status[J].Eur Radiol,2003,45:11-22.
10 高培毅,林燕.脑梗死前期脑局部低灌注的灌注成像表现及分期[J].中枢神经系统放射学,2003,37:882-886.
11 Jongen LM,Van der worp HB,Waaijer A,et al.Interrelation between the degree of carotid stenosis,collateral circulation and cerebral perfusion[J].Cerebrovasc Dis,2010,30:277-284.
12 叶长安.脑梗塞前期患者的脑血流动力学的改变及多排灌注成像表现及分期[J].中国和杂志,2015,12:42-44.