螺旋CT灌注成像检测急性中重度颅脑损伤局部脑血流参数的意义

Effect of computed tomography perfusion imaging on regional cerebral blood flow in moderate to severe traumatic brain injury

目的通过螺旋CT灌注成像(CTP)检测局部脑血流参数,探讨其在中、重度颅脑损伤中的相关性,对比研究其变化规律。方法根据格拉斯哥昏迷量表(GCS)评分选择32例中型和重型颅脑损伤患者进行CTP检查,检测局部脑血流量(r CBF)、局部脑血容积(r CBV)、血液通过组织的平均通过时间(MTT),分析三者间的相关性及其与颅脑损伤程度的关系。结果患者脑组织损伤部位的r CBV和r CBF明显低于对侧,MTT显著高于对侧(均P<0.05);重型组r CBF和r CBV明显低于中型组(均P<0.05)。手术组患者术前与术后第3 d对比,患侧r CBV明显高于术前,而术后MTT则显著低于术前(均P<0.05);中、重型颅脑损伤患者创伤部位的r CBV与格拉斯哥预后量表(GOS)评分呈正相关,而MTT、r CBF与GOS评分无相关性。结论通过CTP检测患者损伤部位的r CBF、r CBV和MTT可判断脑损伤的程度和预后,对指导临床医师治疗有着重要的意义。

Objective To investigate the correlation between the severity of brain injury and regional cerebral blood flow （rCBF）, regional cerebral blood volume （rCBV） or mean transition time （MTT） .Methods 32 patients of brain injury were included and divided into moderate and severe group based on their GCS scores . The rCBF, rCBV and MTT were determined by computed tomography perfusion （ CTP） imaging after admittion .Results rCBV and rCBF of injured area were significantly lower than that in contralateral side , and MTT was significantly higher （all P〈0.05）. The rCBF and rCBV of severe group were lower than in the moderate group （all P〈0.05）.Compared with preoperative and postoperative data , postoperative rCBV was significantly higher than the preoperative , and postoperative MTT was significantly lower than the preoperative .The rCBV and the GOS score was positively correlated , whereas there was no correlation between rCBF and the GOS score.Conclusion rCBF, rCBV and MTT were closely correlated with the severity as well as the prognosis of patients with acute brain injury ,which may be a sensitive index to determine the extent of brain damage and prognosis prediction , and have great significance to guide clinical treatment .