CTA联合全脑血流灌注成像在蛛网膜下腔出血后的临床应用

Clinical application of CTA coupled with whole brain CT perfused blood flow after onset of aneurismal subarachnoid hemorrhage

目的:探讨CTA联合全脑灌注成像在蛛网膜下腔出血(SAH)后的临床应用价值。方法:SAH病人29例,通过双源CT全脑血流灌注(PBV)检查,重建CTA图像和PBV图像,在检出动脉瘤等同时,以灌注参数评估SAH后脑血管痉挛及其所致的脑缺血改变情况。结果:29例病人中检出27例的28个动脉瘤。额、颞、顶、枕叶及小脑PBV值SAH组分别为11.17±3.13;10.92±2.91;11.08±2.53;9.88±3.01;19.83±5.12,对照组分别为17.10±3.60;15.98±5.03;15.84±3.53;16.14±1.86;23.54±4.64,额、顶、枕叶差异显著(P<0.05);存活组与死亡组各脑叶PBV值均未见显著性差异;优势出血侧和非优势出血侧低灌注出现情况无显著性差异。结论:CTA联合全脑PBV灌注成像能够在诊断SAH出血原因的同时显示脑血管痉挛引起的脑组织缺血改变。

Objective： To investigate the clinical application of CTA coupled with whole brain CT perfused blood flow after onset of aneurismal subarachnoid hemorrhage（SAH）.Methods： Perfused blood volume（PBV） values were confirmed in 29 patients with SAH by dual source computed tomography.CTA maps and PBV maps were reconstructed.In the meantime we detectd the aneurysm,we evaluated the change of vasospasm and the cause of cerebral ischemia by the perfusion characteristics.Results： Twenty-eight aneurysms in 27 patients were detected.PBV value in the frontal,temporal,parietal,occipital lobe and cerebellum is 11.17±3.13;10.92±2.91;11.08±2.53;9.88±3.01;19.83±5.12 respectively in the SAH group,and 17.10±3.60;15.98±5.03;15.84±3.53;16.14±1.86;23.54±4.64 respectively in the control group.Significant difference was showed in the frontal,parietal and occipital lobes of the brain（P〈0.05）,but the PBV values had no significant difference in the survival group and the death group.It showed no significant difference of hypoperfusion between bleeding dominant hemisphere and the other one.Conclusions： The cause of the SAH could be detected and the cerebral ischemia due to vasospasm could be showed simultaneously by CTA coupled with whole brain CT PBV.