CT 脑灌注成像与血管成像联合评价缺血性脑血管病术后疗效

Combination of cerebral CT perfusion and CT angiography in the assessment of operation effect in patients with ischemic encephalopathy

目的：探讨 CT 脑灌注成像（CTP）与 CT 血管成像（CTA）联合评价缺血性脑血管病术后疗效的可行性。方法搜集2012年9月至2014年1月苏州大学附属第一医院收治的行颈动脉内膜剥脱术（CEA）13例和行颞浅动脉-大脑中动脉（STA-MCA）搭桥术14例的患者，术前、术后均行脑 CTP 和头颈动脉 CTA 检查。对比分析 CTP 图像感兴趣区手术前后相对脑血流量（rCBF）、相对脑血容量（rCBV）、相对平均通过时间（rMTT）、相对达峰时间（rTTP）变化及疗效。CTA 图像采用 VR、CPR 及 MIP 重建方法显示术前血管狭窄部位、程度，术后血管通畅情况、桥血管走行及吻合口。结果脑 CTP 成像显示，27例患者中19例患者脑组织呈低灌注改变，低灌注区术后 rMTT、rTTP 较术前缩短，rCBF 增加，差异均有统计学意义（均 P<0.05）；rCBV 较术前无明显变化（P>0.05）。CTA 成像显示13例行 CEA 患者术前18支颈内动脉血管有不同程度的狭窄，术后血管均恢复通畅；14例行 STA-MCA 搭桥术患者14条桥血管显示清晰，吻合口通畅。结论脑 CTP 成像能观察手术前后脑灌注改善情况，CTA 可以清晰显示手术前后血管通畅情况，将两者相结合，为评价缺血性脑血管病术后疗效提供可靠的影像学依据。

Objective To assess the operation effect in patients with ischemic encephalopathy by combining cerebral CT perfusion (CTP) and CT angiography (CTA). Methods From September 2012 to January 2014,13 patients with carotid atheromatous plaque stenosis were underwent carotid endarterectomy and 14 patients with middle cerebral artery stenosis were underwent superficial temporal artery and middle cerebral artery (STA - MCA) bypass graft in the First Affiliated Hospital of Soochow University.CTP and CTA examinations were performed in all patients before and after operation. The cerebral perfusion parameters were analyzed quantitatively and qualitatively before and after operation. The cerebral perfusion parameters included relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), relative mean transit time(rMTT) and relative the time to peak (rTTP). CTA images were reconstructed by VR, MIP and CPR. Results 19 patients were found low perfusion changes in brain tissue. The decrease of rMTT and rTTP after therapy was of statistical significance (P<0.05), and the increase of rCBF after therapy was of statistical significance (P<0.05). However, there was no statistical difference between rCBV before and after therapy (P>0.05). In reconstructed CTA images, the narrow arteries were remolded after operation. All the bypass grafts were well shown and the anastomotic stomas were unobstructed. Conclusion It is feasible to evaluate the curative effects of patients with ischemic encephalopathy by combining cerebral CTP images and CTA images.