经颅CEUS评价单侧颈内动脉颅外段重度狭窄或闭塞患者脑灌注成像的可行性

Feasibility of transcranial CEUS in evaluation on cerebral perfusion in unilateral severe extracranial internal carotid artery stenosis or occlusion

目的应用经颅CEUS评价颈内动脉(ICA)颅外段重度狭窄或闭塞患者脑灌注特征,探讨经颅超声灌注成像(UPI)可行性。方法选择经DSA证实的无症状或症状较轻的一侧ICA颅外段重度狭窄或闭塞患者78例,并在24h内采用双盲法完成经颅超声和UPI检查。分析并比较患侧及健侧基底节ROI的开始增强时间(TBE)、达峰时间(TPE)、绝对峰值强度(API)、微循环血流速度(β)、微循环血管容积(A)以及局部组织血流量(Axβ);分析UPI与CT灌注成像(CTP)测得的患侧与健侧参数的比值,即相对达峰时间(rTPE)、相对微循环血流速度(r-β)、相对微循环血管容积(r-A)、相对局部组织血流量(r-Axβ)、相对脑血流量(rCBF)、相对平均通过时间(rMTT)的一致性。结果 78例患者中,排除23例双侧颞窗透声不佳者后,入选55例,患侧与健侧基底节区TBE差异有统计学意义(P<0.05);患侧基底节的β值慢于健侧,Axβ值小于健侧(P均<0.05)。患侧与健侧的API、A值差异均无统计学意义(P均>0.05)。UPI与CTP方法中参数r-TPE与rMTT、r-β与rCBF间的一致性较好,r-A与rCBF、r-Axβ与rCBF间的一致性差。结论 UPI可评价ICA颅外段重度狭窄或闭塞患者脑血流灌注情况。

Objective To observe the application of transcranial CEUS in assessing the cerebral perfusion characteristic with unilateral severe extracranial internal carotid artery（ICA）stenosis or occlusion patients,and to explore the feasibility of transcranial ultrasound perfusion imaging（UPI）.Methods Totally 78 consecutive asymptomatic or mild symptomatic patients with severe ICA stenosis or occlusion confirmed by DSA were enrolled.All the patients were received transcranial color-coded sonography（TCCS）and UPI by double blind method in 24 h.The bilateral perfusion parameters of time to begin enhancement（TBE）,time to peak enhancement（TPE）,absolute peak intensity（API）,microcirculation blood flow velocity（β）,microcirculation blood volume（A）and local cerebral blood flow（Axβ）of ischemic tissue and contralateral tissue were analyzed and compared in ROI of basal ganglia.Consistency with CT perfusion（CTP）and UPI of the ratio of ischemic tissue and contralateral tissue,such as relative time to peak enhancement（rTPE）,relative microcirculation blood flow velocity（r-β）,relative microcirculation blood volume（r-A）,relative local cerebral blood flow（r-Axβ）,relative cerebral blood flow（rCBF）,relative mean transit time（rMTT）were analyzed.Results Among 78 patients,after excluding patients with differences in bilateral temporal acoustic attenuation by the temporal bone,55 patients were enrolled.TBE in ROI of basal ganglia had statistical diffrence between Pischemic tissue and contralateral tissue（P0.05）.Compared with contralateral hemisphere,β-values was slower and Axβwas lower in ischemic tissue（both P0.05）.There were no significant difference between ischemic and normal tissue in the parameters of API and A（P0.05）.The consistency between UPI and CTP,r-βand rCBF,rTPE and rMTT were good,but r-A and rCBF,r-Axβand rCBF were poor.ConclusionThe cerebral perfusion could be evaluated by UPI in patients with unilateral severe ICA stenosis or occlusion.