脑出血血肿周围组织CT灌注成像研究

CT PERFUSION MAPPING OF SURROUNDING INTRACEREBRAL HEMORRHAGE

目的探讨脑出血血肿周围组织的血流动力学特点。方法对27例经临床及颅脑CT确诊为幕上脑出血的病人,于发病6h～2周行CT灌注成像检查,测量血肿体积及血肿中心、血肿周围水肿区、水肿区外(距水肿边缘1cm)及远隔皮质区不同感兴趣区的脑血流量(CBF)、脑血容量(CBV)及脑血流平均通过时间(MTT),对不同区域间及与对侧相应区域间进行比较。结果血肿侧灌注参数图色差从血肿中心到外周均呈阶梯样分布,自血肿中心区向外CBF、CBV逐渐增大,MTT逐渐缩短(F=155.05～457.17,q=3.77～47.81,P<0.01),越靠近血肿边缘区的脑组织灌注越低。血肿周围水肿区内CBF与血肿体积呈线性负相关(r=-0.654,P<0.01)。结论脑出血血肿周围存在低灌注区域,灌注参数水平从血肿中心向外呈阶梯样分布,且低灌注程度与血肿体积相关。

Objective To study the hemodynamic features of peri-hematoma brain tissue in intracerebral hemorrhage （ICH）. Methods ACT perfusion （CTP） was performed in 27 patients with supratentorial ICH （confirmed by cranial CT and clinically） six hours to two weeks after the onset. The cerebral blood flow （CBF）, the cerebral blood volume （CBV） and the mean transit time （MTT） of the different regions in the center of the hematoma, the edema around the hematoma, the zone outside ede- ma （1 cm away from the edge） and the remote cortex were evaluated and compared. Results The aberration from the centre of the hematoma to the remote cortex in all the perfusion parameter maps of these 27 cases appeared as a ladder-like distribution. From the center to the remote cortex, CBF and CBV gradually enlarged, while MTT shortened （F = 155.05 - 457.17, q = 3.77 - 47.81 ,P〈0.01）. The nearer the brain tissue to the hematoma, the lower the perfusion would be. The CBF in the edema was posi- tively linearly correlated with the edema volume （r= -0.654,P〈20.01）. Conclusion Hypoperfusion area exists in the peri-hematoma brain tissue in ICH. The aberration from the centre of the hematoma to the remote cortex in all the perfusion parameter maps shows a ladder-like distribution, the degree of hypoperfusion being associated with the volume of the hematoma.