脑CT灌注成像在脑动脉狭窄介入术后脑过度灌注综合征的应用

Application of cerebral CT perfusion imagingin the diagnosis of patients with intracranial and extracranial artery stenosis and its value in predicting the occurrence of cerebral hyperperfusion syndrome after stenting

目的:探讨脑CT灌注成像(cerebral CT perfusion imaging,CTP)检查用于颅内外动脉狭窄(intracranial and extracranial arterial stenosis,ICAS)的诊断应用及预测支架成形术后发生脑过度灌注综合征(cerebral hyperperfusion syndrome,CHS)的预测价值。方法:收集分析南阳市中心医院2020年12月至2021年12月,100例经支架置入术前检查确诊为颅内外动脉狭窄的患者,同时所有患者术前均接受CTP检查。分析支架置入术后发生CHS与非CHS患者的术前CTP的CTP参数,对患者术后发生CHS的预测价值。结果:CTP检查显示低灌注颅内外动脉狭窄患者患侧局部脑血容量(regional cerebral blood flow,rCBF)较健侧降低,患侧脑血流体积(regional cerebral blood volume,rCBV)较健侧增加,局部平均通过时间(regional mean transit time,rMTT)、局部达峰时间(regional time to peak,r TTP)较健侧延长,差异有统计学意义(P <0.05);发生CHS的患者的术前rTTP、rMTT较非CHS组患者延长,差异有统计学意义(P <0.05);术前CTP参数rMTT、rTTP对患者支架置入术后发生CHS具有预测价值。结论:CTP可以作为一种很有前途的临床诊断工具来诊断颅内外狭窄的患者,能反应血流动力学变化。rMTTP、rTTP对支架成形术后是否发生CHS有一定的预测。

Objective:The purpose of this study was to investigate the diagnostic application of cerebral CT perfusion imaging(CTP)in intracranial and extracranial arterial stenosis(ICAS)and its value in predicting the occurrence of cerebral hyperperfusion syndrome(CHS)after stenting.Methods:From December 2020 to December 2021,100 patients diagnosed with intracranial and extracranial artery stenosis by pre-stenting examination in our hospital were collected and analyzed,and all patients received CTP examination before surgery.The CTP parameters of preoperative CTP in patients with and without CHS after stenting were analyzed to predict the value of postoperative CHS.Results:CTP examination showed that in patients with hypoperfusion extracranial and intracranial arterial stenosis,the rCBF of the affected side was lower than that of the healthy side,rCBV was increased,and the rMTT and rTTP were longer than those of the healthy side,and the difference was statistically significant(P<0.05).The preoperative rTTP and rMTT were longer than those in the non-CHS group,and the difference was statistically significant(P<0.05).In addition,the preoperative CTP parameters rMTT and rTTP had predictive value for the occurrence of CHS after stent placement.Conclusions:CTP can be used as a promising clinical diagnostic tool to diagnose patients with intracranial and extracranial stenosis,which can reflect hemodynamic changes.In addition,CTP parameters rMTT and rTTP can predict whether CHS occurs after stenting,so as to evaluate the clinical efficacy of stent placement.