CT脑灌注联合血管成像在烟雾病血管重建术中的应用价值

Application value of CT brain perfusion combined with angiography in vessel revascularization in moyamoya disease

目的探讨CT灌注(CTP)联合CT血管成像(CTA)分析在烟雾病(MMD)血管重建术中的意义。方法对18例烟雾病患者于术前及直接重建术后1周、间接重建术后3个月分别行CTP、CTA检查,对手术前、后术侧额、颞叶的CBV、CBF、MTT、TTP进行定量、定性及对比分析,评估颈内、颅内、外动脉的血管情况,为血管重建术术前制定手术方案、选择手术侧别,术后评价吻合血管的通常及手术疗效。结果 18例患者中1例行直接重建,术后吻合血管通畅,手术后术侧额、颞叶与术前比较,CBV、CBF增加,MTT不变、TTP延长,17例行间接重建,术后侧枝吻合血管形成,手术前、后术侧额、颞叶比较,CBF、CBV增加,MTT、TTP降低,差异有统计学意义(P<0.05)。结论 CTP联合CTA能获得血管成像及全脑灌注成像,有助于MMD术前治疗方法的选择和术后疗效观察。

Objective To investigate the significance of the CT perfusion （CTP） combined with CT angiography （CTA） in moyamoya disease （MMD）. Methods 18 patients with MMD were examined by CTP and CTA before and 1 week after immediate reconstruction and 3 months after indirect reconstruction, and then, the quantitative and qualitative values of CBV, CBF, MTT, TTP of the lateral frontal and the lateral temporal lobe were comparedbefore and after the reconstruc- tion, and the intracranial and extracranial arterial vessels were assessed so as to provide the support for preoperative surgi- cal planning on revascularization, to determine which one should be selected in operated side, and to offer the postoperative evaluation for vascular anastomosis. Results Of these 18 patients with vascular anastomosis, one underwent direct recon- struction. After the reconstruction, is normal. The CBV, CBF, MTT, TTP of the operative side in the lateral frontal and the lateral temporal lobe were normalcompared with those in preoperation. CBV andCBF were increased, MTT was un- changed, and TTP was extended. The other 17 cases, which were subjected to indirect reconstruction, showed collateral vascular anastomosis after surgery. As for theCBV, CBF, MTT, TTP of the operative side in the lateral frontal and the lateral temporal lobe, compared with those in preoperation, CBF, CBV was increased, MTT and TTP were decreased brain perfusion imaging, thereby contributing to MMD in preoperative planning and postoperative evaluation.