脑CT灌注对颅骨修补前后脑血流变化的评价

CT Perfusion Evaluation of Cerebral Blood Flow Before and After Early Cranioplasty

目的探讨CT脑灌注量的变化对评价早期颅骨修补手术的临床价值。方法对10例早期行颅骨修补手术患者在颅骨修补前3天和术后7~10天应用256排螺旋CT行脑灌注扫描,记录缺损处皮层、大脑额叶顶叶枕叶及颞叶皮层、基底节和丘脑区域灌注图像上参数值。分析颅骨修补前后缺损处大脑皮层与健侧皮层,双侧大脑皮质,基底节和丘脑相关区域血流灌注数据的变化。结果术前健侧与患侧对比无显著差异。术后缺损侧的皮层脑血流量（CBF）（t=5.565,P=0.001）、脑血容量（CBV）（t=7.437,P〈0.001）均较健侧高。术前健侧顶叶CBF（t=-1.955,P=0.098）、CBV（t=-2.135,P=0.077）较术后低。术前患侧顶叶CBF（t=-2.405,P=0.053）、CBV（t=-2.133,P=0.077）较术后低,术前患侧皮层CBF（t=-4.407,P=0.005）、CBV（t=-4.663,P=0.004）较术后低,术前到达峰值时间均较术后长（P〈0.05）。结论颅骨缺损早期（2个月内）,缺损侧与健侧灌注量比较未见明显的下降。术后缺损侧皮层CBF及CBV的升高,提示修补手术能够明显改善患侧脑组织灌注,进而对患侧神经功能的恢复有帮助。因此早期颅骨缺损修补手术,对创伤早期的神经功能恢复具有重要的临床意义。

Objective To discuss the clinical application of cerebral perfusion CT scanning in evaluating early cranioplasty.Methods A total of 10 patients undergoing early cranioplasty were enrolled in this study.Three days before and7- 10 days after cranioplasty,256-slice spiral cerebral perfusion CT scanning was carried out in all patients.The changes of regional cerebral blood flow in 1- 2 days before and 10- 14 days after surgery were determined.The cerebral blood flow at the injured side cortex,contralateral cortex,basal nuclei and thalamus were calculated,the results were compared with those at the healthy side.Results Before the cranioplasty,no statistically significant difference in regional cerebral blood flow existed between the injured side and the healthy side.After the cranioplasty,CBF and CBV of injured side cortex were higher than those of the healthy side（P 0.05）.Before the cranioplasty,CBF and CBV of the parietal lobe of the brain at the healthy side were lower than those determined after the surgery.Before the cranioplasty,CBF and CBV of the parietal lobe of the brain at the injured side were lower than those determined after the surgery.Before the cranioplasty,CBF and CBV of the brain cortex at the injured side were lower than those determined after the surgery（P 0.05）.Preoperative TIP was longer than postoperative one.Conclusion The early stage of skull defect（within 2 months）,the cerebral blood flow at the diseased side shows no obvious decrease when compared with that at the healthy side.After the cranioplasty,the cerebral blood flow of the cortex at the diseased side is significantly increased,indicating that the surgery can distinctly improve the cerebral tissue perfusion of the injured side and thus to promote the recovery of the brain.Therefore,early cranioplasty to repair the skull defect is of great clinical significance.