单侧大脑中动脉狭窄的容积CT灌注研究

Volume CT Perfusion in Unilateral Middle Cerebral Artery Stenosis

目的探讨128层容积CT脑灌注评价大脑中动脉(MCA)重度狭窄或闭塞病变的临床价值。资料与方法收集2013年7月-2014年12月武汉市第一医院收治的单侧MCA重度狭窄或闭塞患者35例,行容积CT脑灌注扫描并获得CTP容积灌注参数,包括脑血流量(CBF)、脑血容量(CBV)、达峰时间(TTP)、平均通过时间(MTT),同时获得动态CT血管成像(4D-CTA)图像。结果 3例患者表现为TTP延迟,CBF、CBV、MTT未见明显差异。32例病变区CBF较对侧降低,但差异无统计学意义(P>0.05);CBV增加、TTP和MTT延长,差异有统计学意义(P<0.05)。Mc Nemar检验显示4D-CTA与DSA诊断MCA闭塞差异无统计学意义(P>0.05),且两者一致性较好(Kappa=0.861,P<0.05)。结论 128层容积CT脑灌注能同时明确MCA重度狭窄或闭塞患者的脑灌注异常和血管狭窄,具有重要的临床价值。

Purpose To evaluate the application value of volume CT perfusion（CTP） protocol with 128-slice CT scanner in patients with unilateral middle cerebral artery（MCA） stenosis or occlusion. Materials and Methods Thirty-five patients with severe unilateral MCA stenosis or occlusion who underwent cerebral volume CTP examination in Wuhan No.1 Hospital between July 2013 and December 2014 were evaluated. The volume CTP parameter maps of cerebral blood flow（CBF）, cerebral blood volume（CBV）, mean transit time（MTT） and time to peak（TTP） were analyzed. Meanwhile, the dynamic CT angiography（4D-CTA） images were obtained. Results In three patients, CBF, CBV and MTT were observed normal but TTP was delayed. In the other thirty-two patients, CBF in the affected side was lower than that in the contralateral side（but difference without significance： P〉0.05）. The increased CBV, prolonged TTP and MTT were also detected in the affected side compared with the contralateral side（difference with significance： P〈0.05）. Mc Nemar test showed 4D-CTA and DSA diagnosis of middle cerebral artery occlusion were not significantly different（P〈0.05）, and they had better consistency（Kappa=0.861, P〉0.05）. Conclusion Brain volume CTP protocol with 128-slice CT scanner provides valuable information about cerebral artery abnormalities and hemodynamic changes in patients with severe stenosis or occlusion of MCA. It has great value for clinical application.