平板探测器-实质血容量检测评价颈动脉内膜剥脱术围术期脑组织血流灌注

Application of FPD- PBV testing technique for the evaluation of perioperative cerebral perfusion of carotid endarterectomy

目的 总结分析平板探测器（FPD）-实质血容量（PBV）检测技术在颈动脉内膜剥脱术（CEA）患者围术期脑组织灌注评价中应用的可行性及临床价值。方法 连续收治的40例明确诊断为单侧症状性颈内动脉重度狭窄（70%～99%）患者均经复合手术室头颈部经颅多普勒超声和（或）全脑DSA评估并接受CEA手术，术前、术后即刻作FPD？蛳 PBV检测，评估脑组织血流灌注变化。结果 FPD-PBV技术可很好地检测CEA围术期患者脑组织血流灌注。40例患者均为单侧症状性颈内动脉起始段重度狭窄（左侧18例，右侧22例），术前患侧脑血流灌注明显低于健侧（P＜0.05）。顺利完成CEA术后DSA显示颈内动脉再通良好，颅内分支血流恢复，患侧脑血流灌注较术前增加（P＜0.05），其中22例术后脑灌注改善，但仍低于健侧（＜10%）；15例高于健侧（＜5%）；3例与健侧相等。术后患侧和健侧脑灌注间差异无统计学意义（P＞0.05）。结论 FPD- PBV检测是一种可行的、有较高临床应用价值的成像技术，可用于半定量分析脑灌注变化，为围术期治疗决策和疗效评价提供更多有价值信息。

Objective To investigate the feasibility and clinical application of flat panel detector （FPD）-parenchymal blood volume （PBV） testing technique in evaluating cerebral perfusion during carotid endartereetomy （CEA）. Methods A total of 40 consecutive patients with proved unilateral symptomatic carotid artery severe stenosis （70%-99%） were included in this study. All patients were evaluated by transcranial Doppler ultrasound and/or whole brain DSA, and CEA was performed in hybrid operating room. FPD- PBV testing was employed before and immediately after CEA to assess the changes of cerebral blood flow perfusion. Results FDP-PBV technique could well detect the cerebral blood flow during perioperative period of CEA. All 40 patients had unilateral symptomatic severe stenosis of the initial segment of internal carotid artery （left side in 18 patients and right side in 22 patients）. Before CEA, the cerebral blood perfusion of the affected side was significantly lower than that of the healthy side （P〈0.05）. After the successful completion of CEA procedure, DSA examination showed that the internal carotid artery was well re-opened, the intraerania] branch blood flow returned, the cerebral blood perfusion of the affected side was increased （P〈0.05）. Among the 40 patients, improvement of cerebral blood perfusion of the affected side was seen in 22 patients although the blood perfusion was still lower than that of the healthy side （〈10%）; in 15 patients the blood perfusion of the affected side was higher than that of the healthy side （〈5%） ; and in 3 patients the blood perfusion of the affected side was equal to that of the healthy side. After CEA, the difference in cerebral blood perfusion between the affected side and the healthy side was not statistically significant （P〉0.05）. Conclusion FPD-PBV testing is a feasible and highly valuable imaging technology, it can be used for semi-quantitative analysis of cerebral perfusion changes and provide more valuable information for making the perioperative treatment decision and for the evaluation of curative effect.