双源CT血管成像评价颅内外血管重建术治疗烟雾病

Dual-source CTA in pre-and post-operative assessment of extracranial-intracranial bypass in patients with Moyamoya disease

目的探讨双源CTA（DSCTA）在颅内外血管重建术治疗烟雾病（MMD）术前及术后评估中的应用价值。方法回顾性分析35例接受颅内外血管重建术的MMD患者，共37条搭桥血管。术前1周内行DSCTA及DSA评估颞浅动脉，术后1周复查DSCTA随访搭桥血管通畅性；对其中11例患者的12条搭桥血管于术后3～6个月内再次行DSCTA检查。由2名影像医师术前以3分法（优秀、良好、差）对DSCTA显示颞浅动脉进行评分，术后以5分法对搭桥血管通畅性进行评分。结果术前37条颞浅动脉均通畅，DSCTA显示为优秀32条（32／37，86．49％），良好5条（5／37，13．51％）。术后1周搭桥血管平均通畅性评分为2．95±1．05，通畅率为64．86％（24／37），术后6个月平均通畅性评分（3．75±0．97）及通畅率（11／12，91．67％）均较术后1周有所提高。结论DSCTA在颅内外血管重建术治疗MMD的术前评估及术后随访中具有高度临床应用价值。

Objective To observe the value of dual-source CTA （DSCTA） for pre-and postoperative assessment of extracranial-intracranial bypass in patients with Moyamoya disease （MMD）. Methods A consecutive series of 35 MMD patients were retrospectively analyzed, and 37 superficial temporal artery （STA） were enrolled. Both DSCTA and DSA for STA were performed 1 week before surgical operation. DSCTA was initially performed within I week after surgery to as- sess the bypass patency, and then performed in 11 patients for 12 STA 3--6 months postoperatively for follow-up. Images were observed by two radiologists independently. Image quality of STA was evaluated using 3-score scale （good, moderate and poor）, while the quality of bypass visualization was evaluated using 5-score scale. Results Preoperative image quality of DSCTA for STA was good （32/37, 86.49%） or moderate （5/37, 13.51%）, the mean score of bypass visualization and the patency rate in the immediate postoperative period was 2.95±1.05 and 64.86 % （24/37）, respectively. The quality of 12 bypass visualization （3.75±0.97） and the patency rate （11/12, 91.67%） were all improved during the follow-up period. Conclusion DSCTA is an effective, non-invasive tool for preoperative planning and postoperative follow-up of extracra- nial-intracranial bypass surgery in patients with Moyamoya disease.