CT灌注成像短期评估烟雾病行脑血管重建术的血运重建疗效

CT Perfusion Imaging for Short-Term Evaluation of Revascularization in Moyamoya Disease Patients Undergoing Cerebral Revascularization

目的探讨CT灌注成像(CTP)技术检验接受脑血管重建术的烟雾病患者手术疗效。方法28例烟雾病患者接受脑血管重建术(颞浅动脉-大脑中动脉搭桥术联合脑-硬膜-颞肌贴敷术)等方法,手术前后分别行CTP检查。在手术前后分别测量并比较患者术侧灌注参数的绝对值、术侧与对侧镜像区灌注参数的相对值,对比分析脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)。结果28例烟雾病患者桥血管均显示通畅,CTP术侧灌注参数中比较后CBF(颞叶和顶叶)、CBV(额叶、颞叶、顶叶)、MTT(顶叶)、TTP(额叶、颞叶、顶叶)存在统计学意义(P<0.05)。术侧比镜像对照区的rCBF(颞叶)、rMTT(顶叶)、rTTP(顶叶)存在统计学意义(P<0.05)。结论手术干预后,烟雾病患者的脑血流重建有所改善,特别是在严重的灌注受损患者中。因此,CTP不仅能反映脑微循环信息的功能成像,有助于判断烟雾病脑缺血的部位、严重程度、选择手术侧别和手术方式,更能快速了解术后缺血情况是否得到改善,可作为检验手术疗效的重要检测方法。

Objective To evaluate the efficacy of CT perfusion imaging(CTP)for patients with moyamoya disease who underwent revascularization.Methods Twenty-eight patients with moyamoya disease underwent cerebral revascularization(superficial temporal artery-middle cerebral artery bypass graft combined with brain-dura-temporalis muscle grafting).CTP examination was performed before and after operation.The absolute value of intraoperative perfusion parameters and the relative value of intraoperative and contralateral mirror perfusion parameters were measured and compared before and after surgery.Cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT)and time to peak(TTP)were compared and analyzed.Results The bridging vessels of 28 patients with moyamoya disease showed patency.There were significant differences in postoperative perfusion parameters of CBF(temporal lobe and parietal lobe),CBV(frontal lobe,temporal lobe,parietal lobe),MTT(parietal lobe)and TTP(frontal lobe,temporal lobe,parietal lobe)(P<0.05).There were significant differences in rCBF(temporal lobe),rMTT(parietal lobe)and rTTP(parietal lobe)in the mirror control area(P<0.05).Conclusion After surgical intervention,CBF revascularization was improved in MMD patients,especially in patients with severe perfusion impairment.Therefore,CT perfusion imaging can not only reflect the functional imaging of brain microcirculation information,but also help to judge the location,severity,surgical side and surgical method of MMD cerebral ischemia.It can also quickly understand whether the postoperative ischemia is improved,and can be used as an important examination method to test the efficacy of surgery.