急性基底节区自发性脑出血周围血管表面通透性与血肿及水肿体积的CT灌注分析

CT perfusion analysis on the association of permeability surface with hematoma and edema volume in acute spontaneous putaminal and thalamic hematoma

目的采用CT灌注成像对急性期基底节区自发性脑出血后血肿周围血脑屏障通透性进行定量评估，获得血管表面通透性指数（PS），并探讨其与血肿及水肿体积的相关性。方法2015年10月至2016年12月问，连续人组温州医科大学附属第一医院保守治疗且经一站式CT确诊为急性期基底节区自发性脑出血患者48例。以血肿的最大层面为中心，测量“热点”区、血肿边缘区、外围区、大脑半球及对侧镜像区PS值，并计算相对值rPS（患侧PS／健侧PS），用自带软件测量血肿及水肿体积。结果“热点”区PS[（2．8±1．5）ml·100g^-1·min^-1]和血肿边缘区Ps[（2．1±1．4）ml·100g^-1·min^-1]均较对侧镜像区PS[（1．1±0．5）ml·100g^-1·min^-1]显著增高（均P〈0．001）；血肿外围区PS[（1．1±0．5）ml·100g^-1·min^-1）]和大脑半球PS[（1．1±0．4）ml·100g^-1·min^-1]与对侧镜像区PS[（1．1±0．5）ml·100g^-1·min^-1]比较差异均无统计学意义（均P〉0．05）。“热点”区rPS与血肿边缘区rPS之间差异无统计学意义（P=0．218）；“热点”区及血肿边缘区rPS均高于血肿外围区及大脑半球rPS（均P〈0．001）；血肿外围区rPS与大脑半球rPS之间差异无统计学意义（P=1．000）。血肿中位体积为12．63ml，水肿中位体积为12．36ml。水肿体积与血肿体积呈正相关（r=0．799，P〈0．001）；水肿体积与边缘区Ps呈正相关（r=0．465，P=0．001）；边缘区PS与血肿体积呈正相关（r=0．386，P：0．007）。结论CT灌注成像能够定量评估急性期基底节区血肿周围血脑屏障的破坏，血管表面通透性与血肿体积和水肿形成有关。

Objective To discuss the correlation of permeability surface （PS） with hematoma and edema volume in acute spontaneous putaminal and thalamic hematoma using CT perfusion imaging. Methods A total of 48 acute spontaneous putaminal and thalamic hemorrhage patients were enrolled in this study during October 2015 and December 2016 at the First Affiliated Hospital of Wenzhou Medical University. At the image slice with maximum size of hematoma, PS was measured by drawing various regions of interest （ROI） including ＂ hot spots ＂, perihematomal regions, outward regions, hemisphere regions and contralateral mirror regions. The relative PS （rPS） was calculated as the ratio of ipsilatera] to contralateral PS value in each ROI. Hematoma and edema volumes were traced and obtained with commercial software. Results The ＂hot spots＂ PS （（2.8±1.5） ml·100 g^-1·min^-1） and perihematomal PS （（2. 1 ±1.4） ml·100 g^-1·min^-1 ） were both significantly higher than the PS of the contralateral mirror regions （ （1.1 ± 0. 5） ml·100 g^-1·min^-1） （p 〈0. 001 ）. There was no significant difference in outward regions PS and contralateral mirror regions PS （ P 〉 0. 05 ） , nor in hemisphere regions PS and contralateral mirror regions PS （P 〉0. 05）. There was no significant difference in ＂hot spots＂ rPS and perihematomal rPS （P =0. 218）. The ＂hot spots＂ rPS and Perihematomal rPS were both higher than the rPS of the outward and hemisphere regions （P 〈 0. 01 ）. There was no significant difference in the outward and hemisphere regions （P 〈 0. 01 ）. The median hematoma volume was 12. 63 ml and the median edema volume was 12. 36 ml. The edema volume had a positive association with the hematoma volume（ r = 0.799, P 〈 0. 001 ） and perihematomal PS （r = 0. 465, P = 0.001 ）. Perihematomal PS had a positive association with the hematoma volume （ r = 0. 386,P = 0. 007 ）. Conclusion The damage of blood-brain barrier around acute spontaneous hematoma can be measured via CT perfusion imaging. Perihematomal PS was associated with the hematoma and edema volume.