320排CT全脑动态容积成像联合颈部CTA在慢性脑缺血中的初步应用

The preliminary application of whole brain CT perfusion imaging and neck CT angiography with 320-row-detector dynamic volume CT in patient with chronic cerebral ischemia

目的初步探讨320排CT全脑动态容积成像联合颈部CTA检查对于评估慢性缺血性脑血管病的临床应用价值。方法 54例慢性缺血性脑血管病患者行320排CT头颈联合多参数扫描,对头颈动脉狭窄程度及脑灌注各参数进行分析,参数包括脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)。结果 1发现脑灌注异常41例,共58处脑缺血灶,其中Ⅰ1期9处、Ⅰ2期24处、Ⅱ1期17处、Ⅱ2期8处。灌注参数患侧TTP、MTT和CBF与对侧镜像比较差异有统计学意义;2血管狭窄或闭塞者50例(前循环43例,后循环7例),仅累及头部者19例,仅累及颈部23例,头颈血管不同程度狭窄/闭塞8例(4例责任血管是头部;4例责任血管是颈部);50例中轻度狭窄7例,中度狭窄9例,重度狭窄19例,闭塞15例;相应供血血管重度狭窄或闭塞导致脑灌注异常明显高于轻中度狭窄者(P<0.01)。结论320排CT全脑动态容积成像联合颈部CTA检查能全面显示脑血流灌注参数的变化及相应头颈部供血动脉狭窄程度,为临床早期治疗慢性缺血性脑血管病提供影像学依据。

Objective To explore the clinical value of using whole brain CT perfusion imaging and neck CT angiography with 320-row-detector dynamic volume CT for the assessment of chronic ischemic cerebrovascular diseases. Methods The data of the dynamic CT angiography （4D CTA）, CT brain perfusion and The CTA images of carotid artery were acquired in 54 patients with chronic ischemic cerebrovascular diseases. The narrow rate of the neck and intracranial lesions of vascu- lar and CT perfusion （CTP） parameters, including cerebral blood flow （CBF）, cerebral blood volume （CBV）, mean transmit time （MTT）, time to peak （TTP）, were calculated. Results （D Abnormal cerebral perfusion was found in 41 patients with 58cerebral ischemic lesions, including Ⅰ1 in 9 lesions, Ⅰ2 in 24, Ⅱ1 in 17, Ⅱ2 in 8. The difference of the perfusion parameters of TTP, MTT and CBF of the affected side and mirror area on contralateral side was statistically significant （ P 〈0.05） ; 0 In 50 patients with vascular stenosis or occlusion, 43 cases were procyelic stenosis or occlusion and 7 postcyelic stenosis. 19 were pure cerebral artery stenosis or occlusion and 23 pure internal carotid artery stenosis or occlusion. 8 patients had both carotid artery and cerebral artery stenosis or occlusion. The 50 patients with different intraeranial artery and neck vascular stenosis or occlusion included mild stenosis in 7 cases, moderate stenosis in 9, severe stenosis in 19, occlusion in 15. The incidence of hypoperfusion in patients with severe artery stenosis or occlusion was significantly higher than the patients with mild to moderate atery stenosis （ P d0.01）. Conclusion The whole brain CT perfusion im- aging and neck CT angiography with 320-row-detector dynamic volume CT can fully show position of cerebral ischemia, changes of cerebral blood flow parameters and the degree of stenosis of the corresponding the feeding artery of the head and neck. So, it can provide imaging basis for the early clinical treatment of chronic ischernie eere-brovascular diseases.