双源CT全脑灌注成像对大脑中动脉狭窄时侧支循环状态及预后的评估

Assessment of Collateral Circulation Status and Prognosis in Patients with Middle Cerebral Artery Stenosis by Whole Brain CT Perfusion Imaging Using Dual Source CT

目的探讨全脑CT灌注及动态CT血管成像在评估单侧大脑中动脉（MCA）狭窄或闭塞患者的侧支循环状态及临床预后的价值。方法搜集39例单侧MCA狭窄或闭塞患者的全脑灌注时动态CT血管成像、灌注伪彩图及灌注参数,评估患者的侧支循环的速度和程度、脑组织的血流灌注情况及二者与预后的关系。结果 39例中,32例侧支循环良好者mRS评分为（1.56±1.04）分,7例循环差者mRS评分为（4.43±0.98）分,两组mRS评分差异有统计学意义（t=6.64,P〈0.001）,侧支循环良好者临床预后良好。侧支循环良好者患侧CBF、CBV、MTT、TTD分别为（59.12±12.24）ml/100g·min、（4.39±0.68）ml/100g、（5.51±1.22）s、（6.32±1.86）s,健侧分别为（62.46±9.86）ml/100g·min、（3.94±0.56）ml/100g、（4.37±0.66）s、（3.80±0.84）s,患侧较健侧CBV增高,MTT、TTD延长（t=3.06、6.36、8.70,P〈0.01）,但CBF无统计学意义（t=-1.45,P=0.16）;侧支循环差者患侧CBF、CBV、MTT、TTD分别为（44.42±14.47）ml/100g·min、（3.26±0.76）ml/100g、（6.34±1.58）s、（8.86±2.29）s,健侧分别为（71.43±17.29）ml/100g·min、（4.68±1.01）ml/100g、（4.53±0.68）s、（4.10±1.04）s,患侧较健侧CBF、CBV明显降低,MTT、TTD明显延长（t=-5.42、-3.91、2.91、4.75,P〈0.05）。结论全脑CT灌注成像及相应动态CT血管成像能很好的评估一侧大脑中动脉狭窄或闭塞时的侧支循环状态、脑血流灌注而预测患者的临床预后。

Objective To investigate the value of the whole brain CT perfusion and dynamic CTA in evaluating collateral circulation and prognosis in patients with unilateral middle cerebral artery（ MCA） stenosis or occlusion. Methods The dynamic CTA images and perfusion maps were reconstructed from the whole brain CT perfusion data in 39 patients with unilateral MCA stenosis or occlusion. The velocity of contrast filling and the extent of the contrast filled arteries with time,the qualitative and quantitative CTP data were analyzed to evaluate the prognosis. Results The differences of mRS scores between good collateral circulation（ n = 32） and poor collateral circulation（ n = 7） were statistically significant（ t = 6. 64,P〈0. 001）. The mRS scores of the two groups were 1. 56 ＋ 1. 04 and 4. 43 ＋ 0. 98. The good collateral circulation patients were good prognosis. The CBF,CBV,MTT,TTD were（ 59. 12 ± 12. 24） ml/100 g · min,（ 4. 39 ± 0. 68） ml/100 g,（ 5. 51 ± 1. 22） s,（ 6. 32 ± 1. 86） s in the affected side,in the healthy side were（ 62. 46 ± 9. 86） ml/100 g·min,（ 3. 94 ±0. 56） ml/100 g,（ 4. 37 ± 0. 66） s,（ 3. 80 ± 0. 84） s with good collateral circulation. The CBV was increased and MTT,TTD were prolonged in the affected side with good collateral circulation（ t = 3. 06,6. 36,8. 70,P〈0. 01）,but CBF was not statistically significant（ t =-1. 45,P = 0. 16）. The CBF,CBV,MTT,TTD were（ 44. 42 ± 14. 47） ml/100 g·min,（ 3. 26 ±0. 76） ml/100 g,（ 6. 34 ± 1. 58） s,（ 8. 86 ± 2. 29） s in the affected side,in the healthy side were（ 71. 43 ± 17. 29） ml/100 g·min,（ 4. 68 ± 1. 01） ml/100 g,（ 4. 53 ± 0. 68） s,（ 4. 10 ± 1. 04） s with poor collateral circulation. The CBF,CBV were significantly decreased and the MTT,TTD were significantly prolonged in the affected side with poor collateral circulation（ t =-5. 42,-3. 91,2. 91,4. 75,P〈0. 05）. Conclusion The whole brain CTP and dynamic CTA can be used to evaluate the collateral circulation and cerebral blood flow in patients with unilateral middle cerebral artery occlusion or stenosis.