CT灌注成像评价单侧颈动脉闭塞脑血流动力学与侧支代偿方式

CT perfusion in evaluation of cerebral hemodynamics and collateral flow in unilateral carotid artery occlusion

目的探讨CT灌注成像(CTP)联合DSA评估单侧颈动脉闭塞(CAO)患者侧支代偿方式对脑血流动力学状态影响的价值。方法根据DSA结果将38例患者按不同侧支代偿方式分为两组:单纯初级侧支代偿组(n=14,Ⅰ组)和次级侧支代偿或初级和次级侧支共同代偿组(n=24,Ⅱ组),分别计算两组患者闭塞侧与对侧CTP参数的均值(CBF、CBV、TTP)和相对比值(rCBF、rCBV、rTTP)。比较两组患者闭塞侧与对侧及组间血流动力学差异。结果第Ⅰ组患者闭塞侧与对侧相比仅TTP值延长(t=7.54,P<0.01);第Ⅱ组患者闭塞侧CBV和TTP值较对侧增大(t=5.49、10.70,P均<0.01)。两组rCBF差异无统计学意义(Z=0.68,P=0.494),rCBV与rTTP差异均有统计学意义(Z=2.32、4.50,P均<0.05)。结论 CTP联合DSA可全面评价CAO患者脑血流动力学损伤情况以及不同侧支代偿方式脑血流动力学的差异。

Objective To assess the value of combination of CT perfusion（CTP） and DSA in evaluating influence of different types of collateral flow on hemodynamic parameters in unilateral carotid artery occlusion（CAO） patients.Methods Thirty-eight patients with symptomatic unilateral CAO were divided into 2 groups according to DSA： Primary collaterals group（n=14,group Ⅰ） and secondary collaterals or primary combined secondary collaterals group（n=24,group Ⅱ）.The mean value（CBF,CBV,TTP） and the occluded-to-contralateral ratio（rCBF,rCBV,rTTP） of CTP parameters were measured and compared between two sides and two groups respectively.Results In group Ⅰ,TTP value increased（t=7.54,P〈0.01） in the hemisphere ipsilateral to the occlusion.In group Ⅱ,there were significant increase in CBV and TTP value in the hemisphere ipsilateral to the occlusion（t=5.49,10.70,both P〈0.01）.Statistical difference of rCBV and rTTP was found between two groups（Z=2.32,4.50,both P〈0.05）,while no difference of rCBF was found（Z=0.68,P=0.494）.Conclusion Combined DSA and CTP is a good way to evaluate the state of hemodynamic impairment and the difference of hemodynamic condition with different collaterals.