烟雾病间接血流重建术后早期CT灌注评价

Evaluation of CT perfusion imaging early after indirect revascularization for moyamoya disease

目的探讨CT灌注成像对烟雾病间接血流重建术后早期疗效的评估价值。方法回顾性分析47例经DSA证实的烟雾病的临床资料,其中出血型29例,缺血型18例,均行间接血流重建术。手术前后行头部CT灌注成像检查,分别对脑血流量(CBF)、脑血容量(CBV)、达峰时间(TTP)行半定量和定性分析,对比手术前后症状改善情况。结果烟雾病手术前后CT灌注成像各参数比较,TTP绝对值(TTP值)和相对值(rTTP值)差异均有统计学意义(均P<0.05),余参数值差异均无统计学意义(均P>0.05)。缺血型烟雾病术后症状明显改善9例(50%)。症状改善者,手术前后TTP值和rTTP值差异均有统计学意义(均P<0.05);症状未改善者,手术前后TTP值差异显著(P<0.05),而rTTP值差异无统计学意义(P>0.05)。结论烟雾病间接血流重建术后侧支血管形成和脑血流改善早于造影可见新生血管形成,CT灌注成像为术后早期临床症状明显改善提供合理解释。

Objectives To explore the assessed value of CT perfusion（CTP） in early therapeutic efficacy of indirect revascularization for moyamoya disease.Methods Clinical data of 47 patients with moyamoya disease confirmed by DSA were analyzed retrospectively,including hemorrhagic moyamoya disease in 29 ones and ischemic moyamoya disease in 18.The indirect revascularization was performed in all the patients.The cerebral blood flow（CBF）,cerebral blood volume（CBV） and time to peak（TTP） were analyzed semi-quantitatively and qualitatively by CTP,which was performed before and after the operation.The improvement of symptoms before and after the surgery was compared.Results Between the pre-and postoperative CTP parameters,there were significant differences in the absolute value of TTP（TTP value） and relative value of TTP（rTTP value）（both P〈0.05）,and no significant difference in other parameters（all P〉0.05）.The postoperative symptoms were improved significantly in 9 patients（50%） with chronic ischemic moyamoya disease.Statistical differences in TTP value and rTTP value between before and after the operation were found in the patients whose symptoms were improved（both P〈0.05）.There was a significant difference in TTP value（P〈0.05） while the difference in rTTP value was not significant statistically（P〉0.05） in the patients whose symptoms were not improved between before and after the operation.Conclusions After indirect revascularization for moyamoya disease,the formation of collateral vessels and improvement of cerebral blood flow are much earlier than the formation of new blood vessels detected by DSA,therefore,CTP can provide a reasonable explanation for the improvement of clinical symptoms in the early stage after operation.