亚急性期脑出血后交叉性小脑神经机能联系不能的CT灌注分析

Analysis of crossed cerebellar diaschisis after subacute phase of cerebral hemorrhage with CT perfusion imaging

目的 采用全脑CT灌注（CTP）分析亚急性期自发性脑出血（SPSCH）继发交叉性小脑神经机能联系不能（CCD）及其相关影响因素.方法 2015年7月至2016年10月前瞻性纳入86例经CT平扫确诊的幕上单侧SPSCH患者,行全脑CTP检查,经后处理获取两侧小脑的脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）及达峰时间（TTP）;计算两侧小脑不对称指数（AI）;手动测量血肿体积及幕上CBF最大灌注缺损面积;同时对患者的年龄、性别、发病时间进行统计,采用美国国立卫生研究院卒中量表（NIHSS）评估患者入院时、检查前及出院时的神经功能状态.以单侧幕上血肿伴对侧小脑连续至少2个层面出现灌注减低作为CCD阳性诊断标准,将所有患者分为CCD阳性组和阴性组.采用配对t检验比较CCD阳性组两侧小脑半球灌注参数（CBF、CBV、MTT和TTP）的差异;采用独立样本t检验和χ2检验比较两组间灌注参数及临床变量的差异;采用Pearson相关分析CCD阳性组AI值与临床及影像各变量的相关性.结果 86例SPSCH患者中,CCD阳性组35例,阴性组51例.CCD阳性组血肿同侧及对侧小脑半球的CBF值分别为（40.88±11.23）、（33.91±9.96）ml·100 g-1·min-1,CBV值分别为（3.30±1.18）、（2.75±1.13）ml/100 g,TTP值分别为（22.09±3.98）、（22.88±4.15）s,差异均有统计学意义（t值分别为10.231、8.223、-2.883,P值均＜0.05）.CCD阳性组中,对侧小脑半球CBF、CBV、TTP及MTT出现异常的例数分别为35、32、26、16例.CCD阳性组与阴性组AICBF值分别为（17.10±9.10）%、（-0.95±17.01）%,AICBV值分别为（17.43±11.65）%、（1.55±21.06）%,差异均有统计学意义（t值分别为6.367、4.477,P值均＜0.05）.两组患者在病灶侧别、血肿体积、灌注缺损面积、入院及检查时NIHSS评分上差异均无统计学意义（P值均＞0.05）.CCD阳性组的AICBF、AITTP值与发病天数相关（P值均＜0.05）.结论 CCD是SPSCH后一种常见的继发现象.各灌注参数中,CBF出现异常的比例最高.CCD的严重程度与发病时间有一定相关性,而与年龄、血肿体积、幕上灌注缺损面积及临床NIHSS评分均无相关性.

Objective To analyze crossed cerebellar diaschisis（CCD） after subacute phase of spontaneous cerebral hemorrhage（SPSCH）and it＆#39;s relevant factors with whole-brain CT perfusion（CTP） imaging. Methods Eighty-six patients diagnosed with unilateral SPSCH by CT were prospectively enrolled in our study from July 2015 to October 2016. Whole-brain CTP was performed in each patient.Cerebral blood flow（CBF）, cerebral blood volume（CBV）, mean transit time（MTT）and time-to-peak（TTP） inipsilateral and contralateral cerebellum were manually measured.The asymmetric indexs（AIs） were also calculated. Moreover, the volume of hematoma, the maximumarea of peri-hematomahypoperfusionin CBF and clinical factors（age, gender, time intervals from symptom onset）were analyzed,and NIHSS scores were used to evaluate the neurological status before patient admission, inspection, and discharge.CCD was rated positive when a unilateral supratentorial hematomawas appeared and an accompanying perfusion decrease was showed in the contralateral cerebellum on at least two sequential slices of CTP maps.All the individuals were divided into two groups including CCD-positive groupand CCD-negative group. The perfusion parameters （CBF, CBV, MTT, and TTP）between the contralateral and ipsilateral cerebellum were analyzed by the two-tailed paired t-test in CCD-positive group. The differences in the perfusion and clinical variables between the two groups were analyzed by the independent sample t-test and the Chi-squared test. Therelationships between the AI values and clinical or radiologic variables were assessed with Pearson correlation test. Results We found 35 CCD positive cases and 51 negative cases in the 86 patients.In CCD-positive groups, the perfusion values of cerebellumipsilateral and contralateral to the hematomawere as follows：CBF were （40.88±11.23） vs. （33.91±9.96） ml·100 g-1·min-1, CBV were （3.30±1.18） vs. （2.75±1.13） ml/100 g and TTP were （22.09±3.98） vs. （22.88±4.15） s, respectively, and there was statistical significance （t=10.231,8.223,-2.883,P＜0.05）.In CCD positive group, CBF, CBV, TTP, and MTT of the contralateral cerebellar hemisphere was changed in 35, 32, 26, and 16 cases,respectively.The AI value of CBF（AICBF）in CCD-positive group was （17.10±9.10）%, which was higher than that in the negative group （-0.95±17.01）%, there was statistical significance（t=6.367,P＜0.05）.The AI value of CBV（AICBV）was （17.43 ± 11.65）% in CCD-positive group, also significantly higher than that in negative group which was （1.55±21.06）%（t=4.477, P＜0.05）. No statistical difference（P＞0.05）was found in hematoma location,hematoma volume, supratentorialhypoperfusion area and NIHSS scores（at admission, inspection）between CCD-positive and negative groups.The AICBF and AITTP showed linear correlation with time intervals in CCD-positive patients（P＜0.05）. Conclusions CCD is a common phenomenon in patients with SPSCH.Of all the perfusion parameters,CBF abnormalities are more common.The severity of CCD has a certain correlation with time intervals.There is no significant correlation between CCD and the clinical or radiological data（age, NIHSS scores,hematoma volume, and supratentorial hypoperfusion area）.