亚急性期基底节区血肿周围组织的CT灌注研究

Research of the perihematomal perfusion of subacute basal ganlia hemor-rhage with CT perfusion imaging

目的应用CT灌注成像(CTP)技术定量研究亚急性期基底节区血肿周围组织血流灌注变化,并分析血肿体积、各灌注参数与美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)评分的相关性。方法对15例内科保守治疗的亚急性基底节区血肿患者行CTP检查,同时行NIHSS评分,测量血肿体积,并测量血肿中心、边缘区及外层区、对侧镜像区的脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT),并计算相对灌注参数值rCBF、rCBV、rMTT(患侧/健侧)。结果亚急性期基底节区血肿中心区及边缘区CBF、CBV较对侧镜像区明显降低(P<0.01),中心区MTT较镜像区明显缩短(tMTT=-13.938,PMTT<0.01),边缘区MTT较镜像区有所缩短,但差异无统计学意义(tMTT=2.130,PMTT>0.05)。血肿外层区CBF、CBV较镜像区无明显减低(tCBF=-1.680,PCBF>0.05;tCBV=-0.256,PCBV>0.05),MTT较镜像区延长,但差异无统计学意义(tMTT=1.541,PMTT>0.05)。血肿中心区rCBF、rCBV均较边缘区减低、边缘区较外层区减低(P<0.01),中心区rMTT较边缘区缩短,边缘区rMTT亦较外层区缩短(PrMTT<0.05)。血肿体积与NIHSS评分相关(r=0.621,P<0.05)。亚急性血肿中心区、边缘区和外层区rCBF、rCBV、rMTT与NIHSS评分均无相关性(P>0.05)。结论 CTP检查可证实亚急性基底节区血肿周围组织存在灌注减低,血肿体积可间接反映脑出血患者神经功能缺损状况。

Objective To reserach the perihematomal perfusion in patients with subacute basal ganlia hemorrhage with 320-row volume CT perfusion imaging, and analyze the relationship between the volume of hematomas and the perfusion parameters and the NIHSS scores. Methods CTP was performed in fifteen patients with subacute basal ganlia hemorrhage diagnosed by plain CT, NIHSS grading was carried out at the same time. The volume of the hematomas was measured. The cerebral blood flow（CBF）, cerebral blood volume（CBV） and mean transit time（MTT） of the center,marginal zone and outer zone of hematomas and contralateral area were also measured. r CBF, r CBV and r MTT were calculated by ipsilateral/contralateral value. Results Compared with the contralateral area, the CBF and CBV of the center and marginal zone presented lower perfusion and there was significant statistical difference（P〈0.01）, and the MTT of the center was obviously shorter than that of the mirror area（tMTT=-13.938,PMTT0.01）, and the MTT of the marginal zone was not significantly shorter（tMTT=2.130,PMTT0.05）; The CBF and CBV of the outer zone showed lower perfusion than the mirror area, but there was no significant statistical difference（tCBF=-1.680,PCBF0.05;tCBV=-0.256,PCBV0.05）, MTT was longer, but there was also no significant statistical difference（tMTT=1.541,PMTT0.05）. The r CBF and r CBV in the center were strongly lower than those in the marginal zone, and which in marginal zone were lower than those in outer zone（all P〈0.01）. r MTTs were relatively obviously shorter（Pr MT10.05）. There was significant relationship between the volume of hematomas and NIHSS scores（r=0.621,P〈0.05）, and there was also no significant relationship between the NIHSS scores and r CBF, r CBV, r MTT of the marginal zone or the outer zone（P〈0.05）. Conclusion Hypoperfusion existed in perihematoma region of subacute basal ganlia hematoma, and the volume of hematoma could indirectly indicate the extent of neurological defect of patients with intracerebral hemorrhage.