320排动态容积CT成像评估单侧大脑中动脉闭塞患者侧支循环的应用价值

Application of 320-row-detector dynamic volume CT imaging in evaluating the collateral circulation in patients with unilateral middle cerebral artery occlusion

目的探讨320排动态容积CT全脑成像在评估单侧大脑中动脉(MCA)闭塞患者侧支循环中的应用价值及其对预后的评价作用。方法纳入2011年3月至2015年9月在浙江省人民医院住院治疗的37例单侧症状性MCA闭塞患者。采用320排CT进行多参数全脑灌注扫描,获取常规CTA和4D-CTA图像,分析常规CTA、4D-CTA所示侧支循环状况和金标准DSA图像并作一致性检验,同时计算4D-CTA侧支循环评分与预后的相关性。结果 4D-CTA、常规CTA所示侧支循环良好患者分别为22例(59.4%)、14例(37.8%)。以DSA为金标准,常规CTA、4D-CTA侧支循环评分Kappa值分别为0.58、0.78。4D-CTA所示侧支循环不良患者和侧支循环良好患者间治疗时间窗差异有统计学意义(t=2.27,P=0.029),两者侧支循环评分与随访90 d改良Rankin量表评分呈负相关(r=-0.68,P<0.001)。结论 320排动态容积CT成像是评价单侧症状性MCA闭塞患者侧支循环建立情况的有效方法。4D-CTA比常规CTA能更好地评估侧支血流和预测预后,有助于血管内介入治疗决策。

Objective To investigate the application of 320-row-detector dynamic volume CT imaging of whole brain in evaluating the collateral circulation in patients with unilateral middle cerebral artery （MCA） occlusion, and to discuss its value in predicting prognosis. Methods A total of 37 patients with unilateral symptomatic MCA occlusion, who were admitted to the Zhejiang Provincial People＇s Hospital during the period from March 2011 to September 2015 to receive endovascular treatment, were enrolled in this study. Multiparameter whole brain perfusion scanning was performed with a 320-row-detector CT scanner, the conventional CTA and 4D-CTA images were obtained. The collateral circulation manifestations demonstrated on CTA and 4D- CTA images as well as on DSA （used as gold standard） were analyzed, and the consistency between CTA and DSA was evaluated. The correlation between 4D-CTA collateral flow scores and prognosis was assessed. Results The 4D-CTA and conventional CTA images showed that good collateral circulations were observed in 22 patients （59.4%） and 14 patients （37.8%） respectively. Taking DSA as the gold standard, the collateral circulation Kappa scores of conventional CTA and 4D-CTA were 0.58 and 0.78 respectively. The difference in the therapeutic time window between the patients with poor collateral circulation and the patients with good collateral circulation was statistically significant （ t = 2.27, P= 0.029 ）. A negative correlation existed between the collateral circulation scores and modified Rankin scale （mRS） scores （r =-0.68, P〈0.001）. Conclusion 320-row-detector dynamic volume CT imaging is an effective means for the evaluation of the establishment of collateral circulation in patients with unilateral MCA occlusion. 4D-CTA is superior to conventional CTA in assessing the collateral blood flow as well as in predicting the prognosis, which is very helpful for the making of endovascular treatment decisions.