一站式脑CT成像对烟雾病诊断及颞浅-大脑中动脉搭桥术后桥血管再通与脑灌注恢复的评估研究

Assessment of one-stop brain CT imaging in diagnosing Moyamoya disease,and the recanalization of bridge vessel after bypass operation of superficial temporal-middle cerebral artery and the recovery of cerebral perfusion

目的:探讨320排CT灌注成像对烟雾病颞浅-大脑中动脉搭桥术患者术后桥血管再通及手术前后脑血流变化的评估价值。方法:选取在医院CT科行320排CT灌注成像检查并经数字减影血管造影(DSA)确诊的30例烟雾病患者纳入观察组,另选取30名健康体检者纳入健康对照组。健康对照组仅行CT全脑灌注成像,观察组采用一站式CT脑成像与DSA成像对于侧枝循环评估的烟雾病患者脑血流动力学结果进行相关性分析,评估行颞浅-大脑中动脉搭桥患者桥血管走行及显示情况,比较两组局部脑血容量(rCBV)、局部脑血流量(rCBF)、胸苷三磷酸(TTP)、平均通过时间(MTT)、延迟时间(DLY)等脑灌注参数情况。结果:观察组30例行颞浅-大脑中动脉搭桥术的烟雾病患者,术后CTA均能显示颞浅动脉及大脑中动脉搭桥血管,显示率100%(30/30)。观察组rCBV、rCBF水平低于健康对照组,差异有统计学意义(t=4.927,t=2.924;P<0.05),观察组TTP、MTT及DLY值高于健康对照组,差异有统计学意义(t=7.745,t=9.950,t=5.391;P<0.05)。结论:320排CT灌注成像技术可通过一次性对比剂注射,实现全脑的动态4D信息采集,反映脑组织血流灌注情况,并能准确的评价患者术后搭桥血管情况,对于烟雾病的早期诊断及术后疗效评价方面有独特的优势。

Objective:To explore the assessment value of 320 slices computed tomography(CT)perfusion imaging on the postoperative recanalization of bridging vessels of patients with moyamoya disease who underwent bypass operation on superficial temporal-middle cerebral artery and the changes of cerebral blood flow before and after surgery.Methods:30 patients with moyamoya disease who underwent 320 slices CT perfusion imaging examination in CT department of hospital and were confirmed by digital subtraction angiography(DSA)were divided into observation group,and 30 health persons who underwent physical examination were divided into health control group.The observation group adopted one-stop brain CT imaging and DSA imaging to conduct correlation analysis for the results of brain hemodynamics of patients with moyamoya disease who underwent assessment of collateral circulation,and assessed the route and display status of bridging vessels of patients who underwent bypass operation on superficial temporal-middle cerebral artery.The parameters of cerebral perfusion,which included regional cerebral blood volume(rCBV),regional cerebral blood flow(rCBF),thymidine triphosphate(TTP),mean transit time(MTT)and delay time(DLY),between two groups were compared.In addition,the improved status of new injury severity score(NISS)of clinical surgery of observation group also was analyzed.Results:For the 30 patients with moyamoya disease who underwent bypass operation on superficial temporal-middle cerebral artery,the postoperative CTA of them could display the bridging vessel of superficial temporal artery and middle cerebral artery,which display rate was 100%(30/30).The rCBV and rCBF of observation group were significantly lower than those of health control group(t=4.927,t=2.924,P<0.05),and the TTP,MTT and DLY of observation group were significantly higher than those of health control group(t=7.745,t=9.950,t=5.391,P<0.05).Conclusion:320 slice CT perfusion imaging technique can realize the dynamic 4 dimension(4D)information collection of the whole brain through the injection of one-time contrast agent,and can reflect the perfusion situation of blood flow of brain tissue,and can accurately evaluate the situation of postoperative bypass vessels of patients.It has unique advantages to moyamoya disease in the early diagnosis and the evaluation of postoperative curative effect.