应用脑血容量软件评估降血压球囊闭塞试验前后脑血容量与临床研究

The application of cerebral blood volume software inassessing the cerebral blood volume compara tive study on the clinical manifestations before and afterballoon occlusion testwith hypotension

目的探讨应用脑血容量软件评估降血压球囊闭塞颈内动脉试验（BOT）前后脑血容量与临床表现变化的相关性。方法经全脑血管造影明确诊断为脑血管病并需在治疗前评估颈内动脉能否闭塞而行降血压BOT的1O例患者，其中颈内动脉海绵窦瘘（CCF）8例，颈内动脉海绵窦段巨大动脉瘤1例，CCF伴假性动脉瘤1例。降血压BOT前后在15min内经肘静脉注射碘普罗胺注射液（370g/L）60ml后进行平板CT扫描，应用脑血容量后处理软件生成CBV图像，比较降血压BOT前后轴位相同层面、感兴趣区域平均相对脑血容量（rCBV）值，将其与临床表现变化进行对比。结果临床监测10例患者降血压BOT前后临床症状变化与轴位相同层面rCBV变化的对比结果，降血压BOT阴性8例，暂时闭塞颈内动脉后平均rCBV为1．02±O．06，具有很好的灌注对称性，且临床表现没有改变，其中1例栓塞病灶同时行颈内动脉永久性闭塞，7例行病灶栓塞，保持颈内动脉通畅，8例阴性患者术后均无脑缺血表现。2例患者降血压BOT阳性，暂时闭塞颈内动脉后患者出现意识障碍，对侧肢体偏瘫，且与降血压BOT前对比rCBV分别降低了24％和21％，呈脑血容量低灌注；2例均行病灶栓塞，保持颈内动脉通畅，术后恢复好，无脑缺血并发症。结论降血压BOT前后临床表现变化与rCBV变化明显相关。

Objective To discuss the application of cerebral blood volume software in assessing thecerebral blood volume （CBV） comparative study on the clinical manifestations before and after balloon occlusion test with hypotension. Aiming to find an objective indicator for balloon occlusion test with hypo- tensionwhich is the gold standard of occluding internal carotid artery （ICA）. Methods 10 patients diag- nosed with eerebrovascular disease through digital subtraction angiography （DSA） whounderwent balloon occlusion test （BOT） with hypotension from October 2012 to October 2013, including8 cases of carotid cavernous sinus （CCF） , 1 case of Giant aneurysm on ICA cavernous sinus segment, and 1 case of CCF and pseudoaneurysm. CBV maps were acquiredinSoftware Cerebral Blood Volumeby manual injection of 60 ml CM （370 g/L） before and after balloon occlusion test with hypotension within 15 minutes, from which mean relative CBV （rCBV） of regions of interest （ROIs） was comparedin the same axial view, The change of mean rCBV was compared with the change of clinical manifestations before and after Ballon Occlusion Test with hypotension. Results There were I0 patients were involved inthis study, of which, no ischemic eomplicationswere recognized in 8 patients. Good perfusion symmetry was detected with averaged rCBV 1.02 ± 0. 06. in those 8 patients, 1 patient underwent permanent ICA occlusion with a detachable balloon without acute or delayed neurologic deficit perceived. The others underwent nidus embolization with coils with keeping ICAunobstructed and got well recovered. Two patients failed to tolerate the BOT testwith hypo tensionwho developed in disturbance of consciousness and the contralateral limb hemiplegia. CBVs from the affected hemisphere was significantly lower than those from the unaffected hemisphere in the corresponding regions with mean rCBV reduction close to 24% and 21%. 2 patients underwent nidus embolization with coils with keeping ICA unobstructed and got well recovered. Conclusion CBV maps have a good consis tency with clinical manifestationsbefore and after balloonocelusion testwith hypotension. It can be an objecrive indicator for the gold standard of occluding ICA.