动态CTA对非时间窗内前循环脑缺血患者侧枝及血流状态的评估

Study of dynamic CT angiography in the assessment of collateral circulation and blood perfusion in patients with anterior circulation cerebral ischemic patients without time window

目的:分析动态CTA与最优单期CTA对前循环脑缺血患者的动脉闭塞程度、侧枝循环状态评估的差异,同时评估动脉闭塞程度、侧枝循环状态及全脑CTP与患者预后的关系。方法:回顾性分析45例非时间窗内的前循环脑缺血患者的全脑CTP及相应动态CTA图像数据,定量评估血管闭塞程度、侧枝循环状态,定性评估脑组织的血流灌注。结果:动态CTA较最优单期CTA图能更好评估脑动脉狭窄及侧枝循环(P<0.001)。患侧脑血容量(CBV)主要为基本正常(26例)和升高(15例),脑血流量(CBF)主要为降低(35例)和基本正常(7例);平均通过时间(MTT)主要为升高(41例)。29例患者预后好,16例预后差,两组之间血管闭塞程度、侧枝循环速度差异无统计学意义(P=0.376、0.186),但侧枝循环程度好、脑组织梗死体积和Tmax异常灌注区体积小者,患者预后好(P=0.005、<0.001、0.027)。结论:动态CTA能更好的评估脑缺血患者的动脉狭窄及侧枝循环状态,结合CT平扫及全脑CTP,能为患者的预后管理提供一定依据。

Objective：To analyze the difference of dynamic CT angiography （CTA） and optimal single-phase CTA for the assessment of degree of artery occlusion, collateral circulation status in pa- tients with anterior circulation ischemia, also to evaluate the relation between degree of artery occlu- sion, collateral circulation status, whole brain CT perfusion with the prognosis of the patients. Methods：The data of whole brain CTP and dynamic CTA were analyzed retrospectively in 45 patients with anterior circulation cerebral ischemia without time window. The degree of artery occlusion, collat- eral circulation status were evaluated quantitatively and the cerebral blood perfusion were evaluated qualitatively. Results：Dynamic CTA imaging was better than optimal single-phase CTA in evaluating cerebral artery occlusion and collateral circulation status （P〈0. 001）. The cerebral blood volume （CBV） in these patients was basically normal in 26 cases,increased in 15 cases,the cerebral blood flow was decreased in 35 cases and basically normal in 7 cases. The mean transit time （MTT） was mainly increased （41 cases）. The prognosis was good in 29 cases and poor in 16 cases,no significant statistic difference was existed in the degree of artery occlusion and collateral circulation velocity between these two groups （P= 0. 376,0. 186 respectively）, however, patients with good collateral circulation score, small cerebral infarction volume as well as small abnormal perfusion volume of Tmax showed statisti- cal significance in prognosis （P=0. 005, 〈0. 001,0. 027 respectively）. Conclusion： Dynamic CTA can better assess the arterial stenosis and collateral circulation status in cerebral ischemic patients,which in combination with whole brain CTP and non-enhanced CT provided information useful in the man-agement of prognosis.