脑梗死后CCD的CT全脑灌注图像分析

Analysis of Crossed Cerebellar Diaschisis with Whole Brain CT Perfusion

目的评估脑梗死患者幕上低灌注体积对交叉性小脑神经机能联系不能（crossed cerebellar diaschisis,CCD）的发生及其程度的影响。方法搜集急性及亚急性期单侧幕上新发脑梗死病例115例,在症状稳定期行320排CT全脑灌注扫描。根据CCD情况分为CCD阳性组及CCD阴性组。分别比较急性及亚急性期CCD阳性组与CCD阴性组间大脑低灌注体积。分析幕上低灌注体积与小脑不对称指数的关系。结果急性期CCD阳性组与CCD阴性组间幕上低灌注体积差异无统计学意义（P〉 0. 05）。亚急性期CCD阳性组大脑低灌注体积大于CCD阴性组（P 〈0. 05）。急性期CCD阳性组大脑CBF减低体积与小脑ΔTTP呈线性正相关（P 〈0. 05）,大脑CBV减低体积与小脑ΔMTT呈线性正相关（P 〈0. 05）。亚急性期CCD阳性组大脑MTT延长体积与小脑ΔTTP呈线性正相关（P 〈0. 05）。结论脑梗死患者幕上低灌注体积与CCD的发生及严重程度有关。体积越大,越易发生CCD,并与CCD的严重程度呈线性正相关。

Objective To evaluate the effect of supratentorial hypoperfusion volume on the occurrence and extent of crossed cerebellar diaschisis（ CCD） in patients with cerebral infarction. Methods A total of 115 patients with unilateral supratentorial cerebral infarction in the acute and subacute phase were enrolled. A 320-slice CT whole brain perfusion scan was performed during the stable period of symptoms. According to the CCD situation,it is divided into CCD positive group and CCD negative group. The cerebral hypoperfusion volume between the acute and subacute CCD positive group and the CCD negative group was compared. The relationship between the on-screen low perfusion volume and the cerebellar asymmetry index was analyzed. Results There was no significant difference in the on-screen hypoperfusion volume between the CCD positive group and the CCD negative group（ P〉0. 05）. The cerebral hypoperfusion volume in the subacute CCD positive group was greater than that in the CCD negative group（ P〈0. 05）. There was a linear positive correlation between CBF reduction volume and cerebellar ΔTTP in the acute phase CCD positive group（ P〈0. 05）,and a linear positive correlation between brain CBV reduction volume and cerebellar ΔMTT（ P〈0. 05）. The volume of MTT in the subacute CCD positive group was positively correlated with cerebellar ΔTTP（ P〈0. 05）. Conclusion The on-screen hypoperfusion volume of patients with cerebral infarction is related to the occurrence and severity of CCD. The larger the volume,the more likely the CCD is to occur and is linearly positively correlated with the severity of the CCD.