CT灌注成像评价脑-硬脑膜-动脉血管融通术治疗烟雾病的疗效分析

Assessment of effect of encephalo-duro-arterio-synangiosis on moyamoya disease by CT perfusion

目的探讨CT灌注成像(CTP)在评价脑-硬脑膜-动脉血管融通术(EDAS)治疗烟雾病(MMD)疗效中的应用价值。方法收集自2014年4月至2019年10月济宁医学院附属医院神经外科采用EDAS治疗的38例(42侧)烟雾病患者临床资料,所有患者均于术前、术后行CTP及DSA检查,分别测量术区皮层、对侧镜像区及脑干手术前、后的CTP参数[脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)],计算相对参数值(rCBF、rCBV、rMTT、rTTP),比较手术前、后脑灌注变化及各参数评价手术治疗效果的效能;依据术后DSA显示的侧支血管形成程度将手术半球分为富侧支血管组半球与乏侧支血管组半球,探讨2组间灌注改变差异。结果42侧手术半球术后灌注均明显改善,表现为rCBF值较术前明显升高,rTTP及rMTT值较术前明显降低,差异均有统计学意义(P<0.05)。受试者工作特征曲线(ROC)显示各参数中rTTP的曲线下面积最大(0.897),诊断敏感度为87.5%,特异度为80.8%。26侧手术半球被归为富侧支血管组(61.9%),16侧半球被归为乏侧支血管组(38.1%)。富侧支血管组术后rCBF、rMTT变化值明显优于乏侧支血管组,差异均有统计学意义(P<0.05)。结论CTP能够定量评价MMD患者EDAS术后脑血流动力学的变化,术后rTTP变化可间接反映侧支血管形成程度。

Objective To evaluate the utility of CT perfusion(CTP)for assessment of effect of encephalo-duro-arterio-synangiosis(EDAS)on moyamoya disease(MMD).Methods Thirty-eight adult MMD patients,who underwent EDAS in our hospital from March 2014 to October 2019,were chosen in our study.All patients received CTP and digital subtraction angiography(DSA)before and after surgery;cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT)and time to peak(TTP)in the operative cerebral cortices and their contralateral mirror areas,as well as brainstems were measured respectively;their relative parameter values(rCBF,rCBV,rMTT and rTTP)were calculated with the brainstem as the reference;perfusion changes of cerebral tissues were observed before and after surgery,and efficacies of these parameters in evaluating the surgical treatment effect were compared.According to the degrees of collateral formation detected by postoperative DSA,the 42 hemispheres of these patients were divided into group of good collateral formation and group of poor collateral formation,and the differences of perfusion changes in the two groups were further discussed.Results CTP revealed that cerebral perfusion at surgical side after EDAS was significantly improved in all the 42 hemispheres;significantly increased rCBF,and significantly decreased rMTT and rTTP were noted as compared with those before surgery(P<0.05).Receiver operating characteristic(ROC)curve showed that the area under the curve of rTTP(0.897)was the largest among all parameters,with diagnostic sensitivity of 87.5%and specificity of 80.8%.Twenty-six patients(61.9%)were into the group of good collateral formation and 16(38.1%)were into the group of poor collateral formation;changed values of rCBF and rMTT in the group of good collateral formation were significantly better than those in the group of poor collateral formation(P<0.05).Conclusion CTP can quantitatively evaluate cerebral hemodynamic changes after EDAS in moyamoya disease patients,and postoperative rTTP changes can reflect the degrees of collateral vessel formation.