不同输入动脉对颈内动脉狭窄患者颅脑CT灌注成像参数的影响

Effect of Different Input Arteries on CT Perfusion Imaging Parameters of Brain in Patients with Internal Carotid Artery Stenosis

目的探讨颈内动脉(ICA)不同程度狭窄的慢性脑缺血患者选择不同输入动脉对颅脑CT灌注成像参数的影响。资料与方法回顾性分析临床诊断为慢性脑缺血,完成颅脑CT灌注(CTP)联合头颈部CT血管成像(CTA)检查,且为单侧颈内动脉起始处或颅内段狭窄的40例患者。CTA证实为轻度狭窄、中度狭窄、重度狭窄及闭塞患者各10例。分别选择左侧、右侧大脑中动脉(MCA)M1段及基底动脉(BA)共3组输入动脉,均选择上矢状窦为输出静脉,生成脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)及延迟时间(DT)参数。比较3种输入动脉组间(BA组、健侧MCA组、患侧MCA组)两侧CBF、CBV、MTT、TTP、DT的差异。结果 20例ICA轻、中度狭窄患者,3组不同输入动脉获取的各灌注参数间差异无统计学意义(P>0.05)。20例ICA重度狭窄及闭塞患者,健侧MCA及BA组所得到的灌注参数间差异无统计学意义(P>0.05)。患侧MCA组16例患者的CBF、MTT及DT与另外两组输入动脉间的差异有统计学意义(P<0.05),CBV、TTP差异无统计学意义(P>0.05)。另3例重度狭窄及1例闭塞患者3组获取的灌注参数差异均无统计学意义(P>0.05),且脑血流灌注图像未见异常改变。结论进行全脑CT灌注成像的后处理中,ICA轻、中度狭窄患者可以选择脑内任意较大的动脉作为输入动脉,而在ICA重度狭窄及闭塞患者中要尽量选择健侧的MCA及BA作为输入动脉。

Purpose To explore the effect of different input arteries on CT perfusion imaging parameters of brain in patients with chronic cerebral ischemia with different degree of internal carotid artery(ICA)stenosis.Materials and Methods Forty patients clinically diagnosed as chronic cerebral ischemia and completed CT perfusion(CTP)of brain combined with head and neck CT angiography(CTA)examination were selected,with stenosis seen in the beginning of unilateral internal carotid and intracranial segment,were retrospectively analyzed.Patients with mild stenosis,moderate stenosis,severe stenosis and occlusion were confirmed by CTA,with 10 cases in each condition.Three groups of input arteries,i.e.the left middle cerebral artery(MCA)M1 segment,right MCA M1 segment and basilar artery(BA),were selected for the study,with superior sagittal sinus set as output vein to generate parameters concerning cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT),time to peak(TTP)and delay time(DT).CBF,CBV,MTT,TTP and DT between the three input arterial groups(BA group,unaffected side MCA group and affected side MCA group)were compared.Results In 20 patients with mild and moderate stenosis of ICA,there was no statistical significance concerning the difference in perfusion parameters among 3 groups of varied input arteries(P>0.05).In 20 patients with severe stenosis of ICA and occlusion,there was no statistical significance concerning the difference in perfusion parameters obtained between the unaffected side MCA group and the BA group(P>0.05).There was statistical significance concerning the difference in CBF,MTT and DT between the 16 cases in affected side MCA group and the other two groups with input arteries(P<0.05),with no statistical significance concerning difference in CBV and TTP(P>0.05).In 3 patients with severe stenosis and 1 patient with occlusion,there was no statistical significance concerning difference in perfusion parameters obtained from the three groups(P>0.05),and no abnormal changes were observed in cerebral blood perfusion images.Conclusion In postprocessing of whole-brain CT perfusion imaging,any larger artery in the brain can be chosen as the input artery for patients with mild and moderate stenosis of ICA,and it is advisable to choose unaffected sides of MCA and BA as input arteries for patients with severe stenosis of ICA and occlusion.