双源CT脑灌注成像评估颈内动脉粥样硬化脑血流动力学改变的临床应用价值

Clinical Value of Dual-source CT Cerebral Perfusion Imaging in Assessing Cerebral Hemodynamic Changes in Patients with Internal Carotid Atherosclerosis

目的探讨双源CT灌注成像评价颈内动脉粥样硬化患者脑血流动力学改变的临床应用价值。方法对2012年1月-2013年5月间就诊的30例经过CT血管造影检查确诊颈内动脉粥样硬化所致管腔不同程度狭窄或闭塞患者行全脑灌注成像,分别重建CT灌注成像(CTPI)参数图,包括脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)及达峰时间(TTP)评估脑组织灌注情况。结果 30例颈内动脉粥样硬化患者中,管腔轻度狭窄8例,中度狭窄12例,重度狭窄7例,闭塞3例。狭窄侧与对侧相比,轻度狭窄患者TTP延长(P<0.05),其余各灌注参数差异均无统计学意义(P>0.05);中度狭窄患者狭窄侧MTT、TTP高于对侧(P<0.05);重度狭窄或闭塞患者狭窄侧CBF、CBV低于对侧,MTT、TTP高于对侧(P<0.05)。30例中22例存在灌注异常。结论 CTPI能早期综合性反映脑组织灌注情况,能全面反映颈内动脉粥样硬化所致重度狭窄或闭塞对脑血流动力学变化,为临床治疗提供重要信息,也有利于临床医师制订个体化治疗方案。

Objective To explore the clinical value of dual-source CT perfusion imaging （CTPI） in the assessment of cerebral hemodynamic changes in patients with internal carotid atherosclerosis. Methods Thirty patients diagnosed to have internal carotid atherosclerosis by CT angiography examination with various degrees of stenosis or occlusion were treated between January 2012 and May 2013. Whole brain perfusion imaging was performed on all the patients. We rebuilt the CTPI figure parameters respectively, including cerebral blood volume （CBV）, blood flow （CBF）, mean transit time （MTT） and time to peak （TTP） to assess brain tissue perfusion. Results In the 30 patients with internal carotid atherosclerosis, 8 had mild stenosis lumen, 12 moderate stenosis, 7 severe stenosis and 3 had occlusion. In mild stenosis cases, TTP of stenosis-side vessels was higher than those of coutralateral side （P 〈 0.05）, and there were no significant differences in other perfusion parameters between bilateral vessels among mild stenosis cases （P 〉 0.05）. MTT and TTP of stenosis-side vessels were higher than those of contralateral side in moderate stenosis cases （P 〈 0.05）. In severe stenosis or obstruction cases, MTT and TTP of stenosis-side vessels were higher than those of contralateral side, while CBF and CBV of stenosis-side vessels were lower than contralateral side （P 〈 0.05）. Twenty-two in the 30 cases had perfusion abnormalities, and there was a significant difference between the stenosis side cerebral perfusion and the healthy side mirror area （P 〈 0.05）. Conclusion CTPI can reflect brain tissue perfusion early and comprehensively, and fully reflect internal carotid atherosclerosis caused by severe stenosis or occlusion of cerebral hemodynamic changes, which provides important information for clinical treatment and helps clinicians to formulate individualized treatment plan.