多层螺旋CT灌注在评价大面积颅骨修补术后覆盖皮瓣存活中的作用

The role of multilayer spiral CT perfusion in evaluating the survival of scalp flap after large-area cranioplasty

目的:探讨多层螺旋CT灌注成像(MSCTPI)技术在评价大面积颅骨修补术后覆盖皮瓣存活中的作用。方法:选取颞部颅骨切除术后4月,皮瓣面积在45 cm2左右,颅骨修补术后2周行头皮多层螺旋CT皮瓣灌注检查,其中皮瓣存活组12例,坏死组12例,获得的数据通过体部灌注软件进行分析,并对其BF、BV、TTP行统计学分析。结果:MSCTPI显示坏死组右枕部覆盖皮瓣密度减低,并可见小片状液化坏死,局部皮瓣坏死缺如,右侧颞、枕部皮瓣低灌注(蓝色);存活组的皮瓣密度与健侧一致,灌注伪彩图患侧与健侧颜色相同,坏死组BF、BV较存活组减低,TTP较存活组延长,均有统计学差异,说明坏死组的血供较存活组明显减少。结论:MSCTPI技术能定量评价大面积颅骨修补术后覆盖皮瓣的存活,为临床提供了一种新的量化评价皮瓣血供的方法。

Objective： To explore the role of muhilayer spiral CT perfusion imaging （MSCTPI） technology in evaluating the survival of covered flap after large-area cranioplasty. Method： Four months after temporal craniectomy, the patients with flap areas about 45 cm2 were enrolled, and MSCTPI was performed after 2 weeks post-cranioplasty. There were 12 cases in flap survival group and 12 eases in flap necrosis group. The data were analyzed by body perfusion software, and the BF, BV and TIP were statistically analyzed. Results： MSCTPI showed that the density of right occipital flaps in the necrotic group re- duced, small slices of necrosis could be seen, and a part of flap was absent, the perfusions of right temporal and occipital flaps were low （blue areas）; the density of flaps in survival group were in accordance with healthy sides, perfusion pseudo- maps of flap and healthy sides were of the same color, BF and BV of necrosis group reduced in comparison to that of survival group; TIP of necrosis group prolonged in comparison to that of survival group; there are significantly statistical differences in BF, BV and TYP between two groups. Conclusion： MSCTPI technology can quantitatively evaluate the survival of flaps after large-area cranioplasty. It provides a new clinical method to quantitatively evaluate blood SuDnlv of flaps.