大脑中动脉狭窄或闭塞患者侧支循环320排计算机断层扫描血管成像联合脑灌注成像研究

Study on Collateral Circulation in Patients with Unilateral Middle Cerebral Artery Stenosis or Occlusion by 320-slice Computed Tomography Angiography and Computed Tomography Perfusion Imaging

目的利用320排计算机断层扫描血管成像(computed tomography angiography,CTA)及脑灌注成像(computed tomography perfusion imaging,CTP)探讨单侧大脑中动脉(middle cerebral artery,MCA)重度狭窄或闭塞的急性缺血性卒中患者侧支循环与脑灌注的关系。方法对72例单侧MCA重度狭窄或闭塞的急性缺血性卒中患者行头部320排CTA及CTP检查,根据有无侧支循环分为2组,对2组CTA和CTP情况进行分析比较。结果共入组72例患者,有侧支循环组58例,无侧支循环组14例。有侧支循环组38例(65.52%)MCA闭塞,无侧支循环组中5例(35.71%)MCA闭塞,两组差异有显著性(P=0.041)。有侧支循环组脑灌注代偿率高于无侧支循环组(68.97%vs 21.43%,χ2=10.595,P=0.001);在CTP异常的68例患者中,有侧支循环者54例,无侧支循环者14例,有侧支循环组患侧的脑血容量[35.00(29.92,41.13)ml/100 g vs 26.25(18.23,37.18)ml/100 g]及脑血流量[(2.39±0.73)ml/100 g·min vs(1.75±0.72)ml/100 g·min]高于无侧支循环组,P分别为0.007和0.040。但2组患侧平均通过时间(mean transit time,MTT)及平均达峰时间(time to peak,TTP)差异无显著性。结论 320排CTA联合CTP检查显示急性缺血性卒中患者中有侧支循环者脑灌注代偿率高,而且其脑血容量和脑血流量均高于无侧支循环者。

Objective To study the relationship between collateral circulation and cerebral perfusion in acute ischemic stroke patients with unilateral middle cerebral artery（MCA） of severe stenosis or occlusion by 320-slice computed tomography angiography（CTA） and computed tomography perfusion imaging（CTP）. Methods 320-slice head CTA and CTP were performed in 72 acute ischemic stroke patients with unilateral MCA of severe stenosis or occlusion.All patients were divided into two groups according the status of collateral circulation.Comparisons were made between the results of the two groups in CTA and CTP.Results All of the 72 patients had been enrolled into the study.There were 58 cases in the group of patients with collateral circulation and 14 cases in the group of patients without collateral circulation.The group of patients with collateral circulation had 38 cases（65.52%） of the MCA occlusion,while there were only 5 cases（35.71%） in the other group,the differences between the two groups were significant（P=0.041）.Patients with collateral circulation had a significantly higher rate of cerebral perfusion compensaion than those without collateral circulation（68.97%vs 21.43%,χ^2=10.595,P=0.001）.There were 68 patients with CTP abnormality,and 54 cases of them had collateral circulation while the other 14 cases didn＇t have.The cerebral blood volume（35.00[29.92,41.13]ml/100 g vs 26.25[18.23,37.18]ml/100 g） and cerebral blood flow（[2.39±0.73]ml/100 g-min vs[1.75±0.72]ml/100 g-min） in the affected side in patients with collateral circulation were higher than those of the group without collateral circulation.But there was no significant difference between these two groups on comparing mean transit time（MTT） and time to peak（TTP）. Conclusion 320-slice CTA with CTP examination showed that the patients with collateral circulation had a higher rate of cerebral perfusion,and the cerebral blood volume and cerebral blood flow were also higher than those without collateral circulation.