全脑CTP定量分析颅内动脉粥样硬化性狭窄患者血管表面渗透性

Quantitative analysis of vascular permeability surface area product in patients with intracranial atherosclerotic stenosis with whole brain CTP

目的采用计算机断层扫描灌注成像(CTP)观察颅内动脉粥样硬化性狭窄(ICAS)患者脑组织血管表面渗透性(PS)和血流动力学状态及治疗后改变。方法对59例ICAS患者(ICAS组)及16名志愿者(对照组)行全脑CTP,并对ICAS组17例行责任血管支架植入术。采用定量分析软件测量责任动脉供血区血管PS、血流动力学参数[脑血流量(CBF)、血容量(CBV)及平均通过时间(MTT)],并获得健侧镜像值,比较2组血管PS及血流动力学参数的差异,对比ICAS组支架植入前后血管PS及血流动力学参数变化,分析血管PS与血流动力学参数的相关性。结果相比对照组,ICAS组患侧血管PS值增高、CBF减低、MTT延长(t=7.77、-4.84、7.47,P均<0.05)。相比健侧,ICAS组患侧血管PS值增高、CBF减低、CBV增加、MTT延长(t=-4.38、-4.48、4.49、8.35,P均<0.05);植入支架后患侧血管PS值、CBF、MTT与术前差异均有统计学意义(t=0.95、-4.05、3.50,P均<0.05)。血管PS与MTT、CBV分别呈高度、中度正相关(r=0.86、0.59,P均<0.05),与CBF呈低度负相关(r=-0.31,P<0.05)。结论血管PS可作为定量评价ICAS治疗效果的影像学标志物。ICAS患者患侧脑组织血管PS明显增加,植入支架后较术前明显降低。PS结合血流动力学参数能更准确地反映脑组织病理生理改变,为个性化治疗ICAS及评估疗效提供参考。

Objective To observe vascular permeability surface area product(PS)and hemodynamic status of brain tissue in patients with intracranial atherosclerotic stenosis(ICAS)and the changes after stent implantation with whole brain computed tomography perfusion(CTP).Methods Totally 59 patients with ICAS(implantation group)and 16 volunteers(control group)were collected.All subjects underwent whole brain CTP,and 17 ICAS patients among them underwent responsible vascular stent implantation.Quantitative analysis software was used to measure vascular PS,hemodynamic parameters(cerebral blood flow[CBF],cerebral blood volume[CBV]and mean transit time[MTT])in the responsible artery blood supply area,and the healthy side mirror values were obtained.The differences of vascular PS and hemodynamic parameters were compared between 2 groups.The changes of vascular PS and hemodynamic parameters before and after stent implantation in ICAS group and the correlations of vascular PS and hemodynamic parameters were analyzed.Results Compared with control group,ICAS group had higher vascular PS value,lower CBF and longer MTT(t=7.77,-4.84,7.47,all P<0.05).Compared with the healthy side,increased vascular PS value,decreased CBF,increased CBV and MTT were observed on the affected side in ICAS group(t=-4.38,-4.48,4.49,8.35,all P<0.05).After stent implantation,statistical differences of vascular PS value,CBF,MTT of the affected side were found compared with those before(t=0.95,-4.05,3.50,all P<0.05).There was slight negative correlation between PS value and atrial fibrillation(P<0.05).Vascular PS was highly and moderately positively correlated with MTT and CBV,respectively(r=0.86,0.59,both P<0.05),and negatively correlated with CBF(r=-0.31,P<0.05).Conclusion Vascular PS value can be used as an imaging marker to quantitatively evaluate the therapeutic effect of ICAS.Vascular PS value of the affected brain tissue of ICAS patients increased significantly,but significantly decreased after stent implantation.Vascular PS value combined with hemodynamic parameters can more accurately reflect the pathophysiological changes of brain tissue,therefore providing references for individualized treatment of ICAS and evaluation of efficacy.