CT灌注成像评估Moyamoya病再灌注术后脑血流灌注状态的实验研究

Application of First- pass Quantitative CT Perfusion Imaging in Assessment of Hemodynamic Status of Moyamoya

目的评价CT灌注成像在Moyamoya病再灌注术后脑血流灌注状态评估中的应用价值。方法收集32例Moy—amoya病患者，年龄8～46岁，平均年龄31．4±11．0岁；男性19例，女性13例。应用16层螺旋CT于颞浅一大脑中动脉再灌注手术前后分别行CT灌注扫描（CT perfusion，CTP）、重建脑血流量（cerebral blood flow，CBF）、脑血容量（cerebral blood volume，CBV）、平均通过时间（meantransittime，MTT）及达峰值时间（timetopeak，TTP）灌注伪彩图。对术前、术后及复查灌注参数图进行比较；对于17例患者比较术后CTP图像与DSA结果。结果32例Moyamoya病患者术前CTP检查显示，30例存在双侧额颞叶及基底节区不同程度的CBF降低，CBV增加，MTT及TTP延长区域，伴局部无灌注区；术后CTP检查显示30例术前显示低灌注患者中，16例显示低灌注区域缩小或消失，10例未见明显变化，4例局部可发现血流高灌注征象；17例CTP与DSA结果比较显示，5例结果符合度不佳。2例术前检查显示正常患者，1例较术前无变化，1例显示轻度高灌注征象。8例患者进行了随访CTP检查，其中4例较术后好转，3例与术后比较未见明显变化，1例可见新发低灌注改变。结论cT灌注成像检查可对烟雾病患者的脑血流灌注状态进行有效评估。对烟雾病患者术后血流状态评估具有重要意义。

Objective To assess the cerebral hemodynamic status of moyamoya using perfusion CT imaging. Methods Thirty - two patients [ age 31.4 ±11.0 （8 - 46） years ; male 19, female 13 ] diagnosed as moyamoya disease were studied. Perfusion CT （PCT） ima- ging was performed before and after bypass surgery using 16 - slices CT scanner. Functional maps for perfusion parameters including cere- bral blood flow （CBF） , cerebral blood volume （CBV） , and mean transit time （MTT） were calculated and displayed. Pre -operation and post - operation DSA results were collected and analysed. Results Pre - operation CT perfusion images showed hypoperfusion areas with different degrees in cerebral hemisphere and basal ganglia in all 32 cases. After bypass surgery, CT perfusion images showed marked improvement of hypoperfusion area in 16 cases. No signflcant changes were found in 10 cases, and hyperperfusion changes were displayed in 4 cases. In seventeen cases with CTP and DSA exams, different results between CTP and DSA were found in 5 cases. For 2 cases with normal manifestation on pre - operation PCT images, no obvious change was found in one case, and hyperperfusion was displayed for the other case. Among eight cases with follow - up exams, 4 cases showed improvement of hypoperfusion; no obvious changes were found in 3 cases and in one case, new hypoperfusion lesions were displayed. Conclusion CT perfusion imaging is a helpful method which can refleet hemodynamic status of involved cerebral tissues, can help to predict the severity degree of moyamoya disease and assess revascularization after surgery.