CT灌注成像对脑血肿周围组织灌注的动态观察

Study of Perihematomal Perfusion in Acute and Subacute Intracerebral Hemorrhage with Dynamic CT Perfusion Imaging

目的:应用CT灌注成像对高血压脑出血急性期及亚急性期血肿周围组织血流动力学变化进行动态观察。材料和方法:对27例高血压脑出血病人急性期及亚急性期行CT平扫及CT灌注成像扫描,测量血肿周围组织及对侧镜像区脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、最大层面血肿及周围低灌注区域面积。结果:灌注参数图示急性期血肿周围组织CBF、CBV均较对侧镜像区降低(Z分别为4.213及4.265,P值均小于0.05),MTT较对侧延长(Z=2.631,P<0.05);亚急性期血肿周围组织CBF降低,与急性期比较无明显变化(Z=0.024,P>0.05),亚急性期血肿周围组织CBV亦降低(Z=3.652,P<0.05),但是与急性期比较CBV有较明显升高(Z=2.21,P<0.05)。最大层面血肿面积与周围低灌注区域范围及CBF值经Spearman等级相关分析无直线相关关系(r分别为0.262及0.065,P值均>0.05)。结论:CT灌注成像可以准确地反映高血压脑出血急性期及亚急性期血肿周围低灌注状态。

Purpose： To observe dynamic perfusion status of perihematomal area in acute and subacute intracerebral hemorrhage（ICH） in hypertension patients with dynamic CT perfusion imaging（CTPI） Materials and Methods： Non - contrast CT and dynamic CT perfusion imaging were performed in 27 patients of acute ICH in acute and subacute phase. Cerebral blood flow（CBF）, cerebral blood volume （CBV） and mean transit time（MTT） of ipsilateral perihematoma and contralateral mirroring area were calculated in acute and subacute hemorrhage.Areas of acute hematoma and hypoperfusion zone of perihematoma in the largest section of hematoma were measured. Results： There were significantly decreased CBF and CBV and prolonged MTT in the acute perihematomal zone against contralateral hemisphere（Z = 4. 213, 4. 265, 2. 631, respectively, P 〈 0.05）. Decreased CBF in subacute perihematomal area had no significant difference with that in acute phase（Z = 0. 024, P 〉 0.05） . Decreased CBV in subacute perihematomal area increased significantly compared with CBV in acute perihematomal area（Z = 2.21, P 〈 0.05） . Areas of perihematomal decreased CBF zone and perihematomal CBF had no correlation with areas of hematoma in the same plane（r = 0.262,0.065, P 〉 0.05）. Conclusion： CTPI could assess perihematomal hypoperfusion in different phases of hematoma accurately.