中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2010年
12期
1280-1284
,共5页
体层摄影术,X线计算机%灌注%支架%预后
體層攝影術,X線計算機%灌註%支架%預後
체층섭영술,X선계산궤%관주%지가%예후
Tomography,X-ray computed%Perfusion%Stent%Outcome
目的 探讨CT灌注成像(CTP)评估颈动脉支架(CAS)术后1周与1年的预后关系.方法 选择单侧颈动脉狭窄程度≥60%,对侧颈动脉无明显狭窄的20例CAS术患者.患者术前1周内、术后1周及术后1年均行头颅CTP检查,计算得到患侧与对侧的各参数比值,包括相对血容量(rCBV)、相对血流量(rCBF)及相对平均通过时间(rMTT).术前1周内均行头颅MRI及CT平扫,且术后即刻行头颅CT平扫,术后1年均行头颈部血管造影.将20例患者3个时间点大脑前动脉区(ACA区)、大脑中动脉区(MCA区)、大脑后动脉区(PCA区)、基底节区、前后皮质分水岭区(cortical watershed,CWS)及髓质分水岭区(internal watershed,IWS)的rCBV、rCBF及rMTT参数值进行重复测量的方差分析.结果 术前1周内、术后1周及术后1年3个时间点各区的rCBV差界无统计学意义(P值均＞0.05),PCA区的rCBF、rMTT差异也无统计学意义(P值均＞0.05),余各区的rCBF、rMTT差异均有统计学意义(P值均＜0.01).20例CAS患者术前1周内、术后1周及术后1年rCBF:ACA区0.86±0.06、0.95±0.04、0.98±0.07,MCA区0.81±0.04、1.06±0.04、1.03±0.07,基底节0.84±0.06、0.97±0.04、0.96±0.04,前CWS区0.78±0.03、0.97±0.03、0.96±0.02,后CWS区0.77±0.03、1.00±0.02.0.98±0.03,IWS区0.80±0.04、0.94±0.03、0.93±0.04(F值分别为18.95、146.41、63.03、540.85、415.97、164.19,P值均＜0.01).rMTT:ACA区1.17±0.05、1.04±0.04、1.01±0.06,MCA区1.41±0.06、1.08±0.04、1. 07±0.04,基底节1.20±0.06、1.06±0.04、1.05±0.04,前CWS区1.41±0.05、1.10±0.05、1.09±0.04,后CWS区1.43±0.10、1.07±0.06、1.08±0.06,IWS区1.29±0.10、1.09±0.05、1.11±0.07(F值分别为51.74、248.89、70.08、381.68、288.94、41. 53,P值均＜0.01).两两比较显示,术后1周、1年与术前1周相比差异有统计学意义(P值均＜0.01),而术后1周与1年rCBF、rMTT差界无统计学意义(P值均＞0.05).结论 对于单侧颈动脉狭窄的患者,CAS术具有较好的长期预后.术后1周与术后1年的灌注情况相仿.CAS术后1周CTP复查对预测长期灌注变化具有重要意义.
目的 探討CT灌註成像(CTP)評估頸動脈支架(CAS)術後1週與1年的預後關繫.方法 選擇單側頸動脈狹窄程度≥60%,對側頸動脈無明顯狹窄的20例CAS術患者.患者術前1週內、術後1週及術後1年均行頭顱CTP檢查,計算得到患側與對側的各參數比值,包括相對血容量(rCBV)、相對血流量(rCBF)及相對平均通過時間(rMTT).術前1週內均行頭顱MRI及CT平掃,且術後即刻行頭顱CT平掃,術後1年均行頭頸部血管造影.將20例患者3箇時間點大腦前動脈區(ACA區)、大腦中動脈區(MCA區)、大腦後動脈區(PCA區)、基底節區、前後皮質分水嶺區(cortical watershed,CWS)及髓質分水嶺區(internal watershed,IWS)的rCBV、rCBF及rMTT參數值進行重複測量的方差分析.結果 術前1週內、術後1週及術後1年3箇時間點各區的rCBV差界無統計學意義(P值均＞0.05),PCA區的rCBF、rMTT差異也無統計學意義(P值均＞0.05),餘各區的rCBF、rMTT差異均有統計學意義(P值均＜0.01).20例CAS患者術前1週內、術後1週及術後1年rCBF:ACA區0.86±0.06、0.95±0.04、0.98±0.07,MCA區0.81±0.04、1.06±0.04、1.03±0.07,基底節0.84±0.06、0.97±0.04、0.96±0.04,前CWS區0.78±0.03、0.97±0.03、0.96±0.02,後CWS區0.77±0.03、1.00±0.02.0.98±0.03,IWS區0.80±0.04、0.94±0.03、0.93±0.04(F值分彆為18.95、146.41、63.03、540.85、415.97、164.19,P值均＜0.01).rMTT:ACA區1.17±0.05、1.04±0.04、1.01±0.06,MCA區1.41±0.06、1.08±0.04、1. 07±0.04,基底節1.20±0.06、1.06±0.04、1.05±0.04,前CWS區1.41±0.05、1.10±0.05、1.09±0.04,後CWS區1.43±0.10、1.07±0.06、1.08±0.06,IWS區1.29±0.10、1.09±0.05、1.11±0.07(F值分彆為51.74、248.89、70.08、381.68、288.94、41. 53,P值均＜0.01).兩兩比較顯示,術後1週、1年與術前1週相比差異有統計學意義(P值均＜0.01),而術後1週與1年rCBF、rMTT差界無統計學意義(P值均＞0.05).結論 對于單側頸動脈狹窄的患者,CAS術具有較好的長期預後.術後1週與術後1年的灌註情況相倣.CAS術後1週CTP複查對預測長期灌註變化具有重要意義.
목적 탐토CT관주성상(CTP)평고경동맥지가(CAS)술후1주여1년적예후관계.방법 선택단측경동맥협착정도≥60%,대측경동맥무명현협착적20례CAS술환자.환자술전1주내、술후1주급술후1년균행두로CTP검사,계산득도환측여대측적각삼수비치,포괄상대혈용량(rCBV)、상대혈류량(rCBF)급상대평균통과시간(rMTT).술전1주내균행두로MRI급CT평소,차술후즉각행두로CT평소,술후1년균행두경부혈관조영.장20례환자3개시간점대뇌전동맥구(ACA구)、대뇌중동맥구(MCA구)、대뇌후동맥구(PCA구)、기저절구、전후피질분수령구(cortical watershed,CWS)급수질분수령구(internal watershed,IWS)적rCBV、rCBF급rMTT삼수치진행중복측량적방차분석.결과 술전1주내、술후1주급술후1년3개시간점각구적rCBV차계무통계학의의(P치균＞0.05),PCA구적rCBF、rMTT차이야무통계학의의(P치균＞0.05),여각구적rCBF、rMTT차이균유통계학의의(P치균＜0.01).20례CAS환자술전1주내、술후1주급술후1년rCBF:ACA구0.86±0.06、0.95±0.04、0.98±0.07,MCA구0.81±0.04、1.06±0.04、1.03±0.07,기저절0.84±0.06、0.97±0.04、0.96±0.04,전CWS구0.78±0.03、0.97±0.03、0.96±0.02,후CWS구0.77±0.03、1.00±0.02.0.98±0.03,IWS구0.80±0.04、0.94±0.03、0.93±0.04(F치분별위18.95、146.41、63.03、540.85、415.97、164.19,P치균＜0.01).rMTT:ACA구1.17±0.05、1.04±0.04、1.01±0.06,MCA구1.41±0.06、1.08±0.04、1. 07±0.04,기저절1.20±0.06、1.06±0.04、1.05±0.04,전CWS구1.41±0.05、1.10±0.05、1.09±0.04,후CWS구1.43±0.10、1.07±0.06、1.08±0.06,IWS구1.29±0.10、1.09±0.05、1.11±0.07(F치분별위51.74、248.89、70.08、381.68、288.94、41. 53,P치균＜0.01).량량비교현시,술후1주、1년여술전1주상비차이유통계학의의(P치균＜0.01),이술후1주여1년rCBF、rMTT차계무통계학의의(P치균＞0.05).결론 대우단측경동맥협착적환자,CAS술구유교호적장기예후.술후1주여술후1년적관주정황상방.CAS술후1주CTP복사대예측장기관주변화구유중요의의.
Objective To evaluate 1-week and 1-year outcomes of carotid artery stenting (CAS)using cerebral perfusion CT(PCT). Methods The clinical database of 20 patients with unilateral carotid artery stenosis( ≥60% ) who underwent CAS were retrospectively reviewed. Relative cerebral blood volume (rCBV), relative cerebral blood flow(rCBF) and relative mean transit time( rMTT) were measured by using cerebral PCT within one week before CAS and at one week and at one year after CAS. Cerebral MRI was performed within one week before CAS. The noncontrast CT was performed within one week before CAS and immediately after CAS. The arteriography was performed at one year after CAS. The variance analysis was performed to determine whether there were significant differences of rCBV, rCBF, rMTT in anterior cerebral artery area( ACA area), middle cerebral artery area( MCA area), posterior cerebral artery area( PCA area),basal ganglia area, front and back cortical watershed area( CWS area) and internal watershed area( IWS area) among the different time points. Results In the three measures, there was no significant difference of rCBV in all areas among the three time points( P ＞ 0. 05 ) , and there was no significant difference of rCBF and rMTT in PCA area( P ＞ 0. 05 ), but there were significant differences of rCBF and rMTT in all other areas among the three time ponits(P ＜0. 01). In one week before CAS, at one week and at one year after CAS, rCBF of 20 patients is 0. 86 ±0. 06, 0. 95 ±0. 04, 0. 98 ±0. 07 in ACA area, 0. 81 ±0. 04, 1.06 ±0. 04, 1.03 ±0.07 in MCA area, 0. 84 ±0. 06, 0. 97 ±0. 04, 0. 96 ±0. 04 in basal ganglia, 0. 78 ±0. 03,0. 97 ±0. 03, 0. 96 ±0. 02 in front CWS area, 0. 77 ±0. 03, 1.00 ±0. 02, 0. 98 ±0. 03 in back CWS area,and 0. 80 ± 0. 04, 0. 94 ± 0. 03, 0. 93 ± 0. 04 in IWS area ( F = 18. 95, 146. 41,63.03,540. 85,415.97,164.19, P＜0. 01). rMTT is 1.17 ±0.05, 1.04±0.04, 1.01 ±0.06 in ACA area, 1.41±0.06, 1.08±0.04, 1.07±0.04 in MCA area, 1.20±0.06, 1.06±0.04, 1.05±0.04 in basal ganglia, 1.41 ±0.05,1.10 ±0. 05, 1.09 ±0. 04 in front CWS area, 1.43 ±0. 10, 1.07 ±0. 06, 1.08 ±0. 06 in back CWS area,1.29±0.10, 1.09 ±0.05, 1.11 ±0.07 in IWS area (F=51.74, 248. 89, 70.08, 381.68, 288.94,41.53, P ＜0. 01 ). There were significant differences of rCBF and rMTT between those measured one week before CAS and one week or one year after CAS ( P ＜ 0. 01 ), but there were no significant differences of rCBF or rMTT in any area measured between those at 1 week after CAS and those measured at 1 year after CAS(P＞0.05). Conclusions Hemodynamic outcome at one year after CAS is good in the absence of contralateral carotid artery steno-occlusive disease. In addition, the coherence of results between 1-week and 1-year indicates that the outcome of one week after CAS could predict long-term hemodynamic outcome.
