定量评价症状性颈动脉狭窄内膜切除术前后脑血流动力学及代谢

Quantitative evaluation of cerebral haemodynamics and cerebral metabolites before and after CEA for symptomatic carotid artery stenosis

目的探讨CT灌注(CTP)联合CT血管造影(CTA)及质子磁共振波谱(1H-MRS)评价症状性颈动脉狭窄内膜切除术(CEA)疗效的临床应用价值。方法 16例单侧症状性颈内动脉(ICA)重度狭窄患者行CEA治疗,术后10～14天复查CTP、CTA及1H-MRS,对CEA前后脑灌注参数、ICA狭窄程度以及各代谢物相对含量进行定量比较分析。结果 CEA治疗后CTP显示患侧CBF较术前增高,差异有统计学意义(P<0.05),MTT、TTP较术前明显降低,差异均有统计学意义(P<0.001)。CTA检测CEA术后ICA狭窄处管腔内径及横截面面积较术前增加,差异均有统计学意义(P<0.001)。1H-MRS结果表明患侧NAA/Cho较术前增高,差异有统计学意义(P<0.01),Cho/Cr较术前降低,差异有统计学意义(P<0.05)。结论应用CTP联合CTA、1H-MRS能够定量分析症状性颈动脉狭窄CEA治疗前后脑血流动力学和代谢的改善情况。

Objective To investigate the value of combined using of cerebral CT perfusion （CTP）,CT angiography （CTA） and 1H magnetic resonance spectroscopy （^1H-MRS） for evaluating cerebral haemodynamic and metabolic changes before and after carotid endarterectomy （CEA） in patients with symptomatic carotid artery stenosis. Methods Totally 16 patients with unilateral symptomatic internal carotid artery （ICA） high-grade stenosis underwent CEA. Conventional cerebral plain CT,CTP and CTA as well as ^1H-MRS were performed in all patients 10 to 14 days after CEA. The results of quantitative cerebral perfusion parameters,ICA diameter and area of cross section,relative contents of cerebral metabolites before and after CEA were compared. Results After CEA,the value of CBF statistically increase （P〈0.05）,MTT and TTP significantly decreased in the affected hemisphere comparing with preoperative perfusion parameters （P〈0.001）. The affected ICA diameter and area of cross section after CEA increased （P〈0.001）. ^1H-MRS showed significantly increasing of NAA/Cho （P〈0.01） and decreasing of Cho/Cr （P〈0.05） ipsilateral to the operated side after CEA. Conclusion Combination of CTP,CTA and ^1H-MRS can quantitatively evaluate the improved situation of cerebral haemodynamics and cerebral metabolites after CEA,and provide the basis of imaging for evaluating curative effect of CEA.