中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
14期
6270-6275
,共6页
童秋云%陈伟建%周洁洁%段玉霞%杨运俊%吴楠%王殊%林怡%高凌云%郭翔%张辉
童鞦雲%陳偉建%週潔潔%段玉霞%楊運俊%吳楠%王殊%林怡%高凌雲%郭翔%張輝
동추운%진위건%주길길%단옥하%양운준%오남%왕수%림이%고릉운%곽상%장휘
脑疾病%体层摄影术,X线计算机%灌流
腦疾病%體層攝影術,X線計算機%灌流
뇌질병%체층섭영술,X선계산궤%관류
Brain diseases%Tomography,X-ray computed%Perfusion
目的：探讨320排低剂量容积CT灌注成像在急性（72 h内）幕上自发性脑血肿形成后继发性脑缺血中的诊断优势及应用价值。方法回顾性分析我院2012年7月至2012年12月期间就诊的33例急性幕上自发性脑出血患者的一站式320排低剂量容积CT灌注成像资料。测量患者脑血肿边缘区、外层区及其镜像的灌注参数值，包括脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）和最大峰值时间（TTP），并计算各参数患侧/对侧的相对值，即rCBF、rCBV、rMTT及rTTP。采用配对t检验比较急性期脑血肿边缘区、外层区及其镜像各参数的差异，采用配对t检验比较血肿边缘区和外层区各参数相对值的差异。记录扫描时机器显示的剂量长度乘积（DLP），DLP乘以头部的有效剂量系数得到有效辐射剂量。结果（1）33例脑出血患者中，脑血肿体积最大为94.45 ml，最小为5.72 ml，血肿平均体积为31.75 ml。（2）急性期脑血肿边缘区CBF、CBV、MTT及TTP分别为（16.83±5.89）ml·（100 g）-1·min-1、（1.04±0.41） ml/100 g、（3.70±0.93）s及（20.16±3.07）s，其镜像区域对应值分别为（24.18±6.67）ml·（100 g）-1·min-1、（1.71±0.35）ml/100 g、（4.44±0.75）s及（17.74±3.78）s，血肿边缘区较镜像区域灌注减低，CBF、CBV、MTT及TTP对比均有统计学差异（tCBF=-11.223，PCBF<0.01；tCBV=-11.743，PCBV<0.01；tMTT=-4.641，PMTT<0.01及tTTP=5.035，PTTP<0.01）。（3）急性期脑血肿外层区CBF、CBV、MTT及TTP分别为（24.53±6.97）ml·（100 g）-1·min-1、（1.77±0.38）ml/100 g、（4.51±0.74）s及（17.98±3.49）s，其镜像区域对应值分别为（26.09±7.40） ml·（100 g）-1·min-1、（1.85±0.41）ml/100 g、（4.47±0.80）s及（17.63±3.58）s，血肿外层区CBF及TTP与镜像区域对比有统计学差异（tCBF=-3.586，PCBF<0.01及tTTP=2.620，PTTP<0.05），但CBV及MTT与镜像区域对比无统计学差异（tCBV=-2.007，PCBV>0.05及tMTT=0.662，PMTT>0.05）。（4）急性期脑血肿边缘区rCBF、rCBV、rMTT及rTTP分别为0.70±0.14、0.61±0.20、0.84±0.17及1.16±0.19，外层区灌注较边缘区改善，对应值分别为0.95±0.10、0.98±0.15、1.02±0.09及1.02±0.05。边缘区rCBF、rCBV均较外层区减低，有统计学差异（trCBF＝-8.747，PrCBF<0.01及 trCBV＝-9.057，PrCBV<0.01）；rMTT 较外层区缩短（trMTT＝-5.639， PrMTT<0.01）；而rTTP较外层区延长（trTTP＝4.399，PrTTP<0.01）。（5）33例患者中，肉眼发现10例患者（30%，10/33）两侧小脑半球灌注不对称，其中8例患者（24%，8/33）脑血肿对侧小脑半球出现灌注减低，2例患者（6%，2/33）脑血肿同侧小脑半球出现灌注减低。（6）入组患者头颅CT一站式检查DLP为4244.30 mGy，有效辐射剂量约为9.76 mSv。结论急性幕上自发性脑血肿形成后其周围组织存在低灌注状态，320排低剂量容积CT灌注成像不仅可以显示脑血肿周围的继发性脑缺血，还可以实现全脑灌注成像以发现原发病灶远隔区域的改变，实现对脑血肿的全面评估。
目的：探討320排低劑量容積CT灌註成像在急性（72 h內）幕上自髮性腦血腫形成後繼髮性腦缺血中的診斷優勢及應用價值。方法迴顧性分析我院2012年7月至2012年12月期間就診的33例急性幕上自髮性腦齣血患者的一站式320排低劑量容積CT灌註成像資料。測量患者腦血腫邊緣區、外層區及其鏡像的灌註參數值，包括腦血流量（CBF）、腦血容量（CBV）、平均通過時間（MTT）和最大峰值時間（TTP），併計算各參數患側/對側的相對值，即rCBF、rCBV、rMTT及rTTP。採用配對t檢驗比較急性期腦血腫邊緣區、外層區及其鏡像各參數的差異，採用配對t檢驗比較血腫邊緣區和外層區各參數相對值的差異。記錄掃描時機器顯示的劑量長度乘積（DLP），DLP乘以頭部的有效劑量繫數得到有效輻射劑量。結果（1）33例腦齣血患者中，腦血腫體積最大為94.45 ml，最小為5.72 ml，血腫平均體積為31.75 ml。（2）急性期腦血腫邊緣區CBF、CBV、MTT及TTP分彆為（16.83±5.89）ml·（100 g）-1·min-1、（1.04±0.41） ml/100 g、（3.70±0.93）s及（20.16±3.07）s，其鏡像區域對應值分彆為（24.18±6.67）ml·（100 g）-1·min-1、（1.71±0.35）ml/100 g、（4.44±0.75）s及（17.74±3.78）s，血腫邊緣區較鏡像區域灌註減低，CBF、CBV、MTT及TTP對比均有統計學差異（tCBF=-11.223，PCBF<0.01；tCBV=-11.743，PCBV<0.01；tMTT=-4.641，PMTT<0.01及tTTP=5.035，PTTP<0.01）。（3）急性期腦血腫外層區CBF、CBV、MTT及TTP分彆為（24.53±6.97）ml·（100 g）-1·min-1、（1.77±0.38）ml/100 g、（4.51±0.74）s及（17.98±3.49）s，其鏡像區域對應值分彆為（26.09±7.40） ml·（100 g）-1·min-1、（1.85±0.41）ml/100 g、（4.47±0.80）s及（17.63±3.58）s，血腫外層區CBF及TTP與鏡像區域對比有統計學差異（tCBF=-3.586，PCBF<0.01及tTTP=2.620，PTTP<0.05），但CBV及MTT與鏡像區域對比無統計學差異（tCBV=-2.007，PCBV>0.05及tMTT=0.662，PMTT>0.05）。（4）急性期腦血腫邊緣區rCBF、rCBV、rMTT及rTTP分彆為0.70±0.14、0.61±0.20、0.84±0.17及1.16±0.19，外層區灌註較邊緣區改善，對應值分彆為0.95±0.10、0.98±0.15、1.02±0.09及1.02±0.05。邊緣區rCBF、rCBV均較外層區減低，有統計學差異（trCBF＝-8.747，PrCBF<0.01及 trCBV＝-9.057，PrCBV<0.01）；rMTT 較外層區縮短（trMTT＝-5.639， PrMTT<0.01）；而rTTP較外層區延長（trTTP＝4.399，PrTTP<0.01）。（5）33例患者中，肉眼髮現10例患者（30%，10/33）兩側小腦半毬灌註不對稱，其中8例患者（24%，8/33）腦血腫對側小腦半毬齣現灌註減低，2例患者（6%，2/33）腦血腫同側小腦半毬齣現灌註減低。（6）入組患者頭顱CT一站式檢查DLP為4244.30 mGy，有效輻射劑量約為9.76 mSv。結論急性幕上自髮性腦血腫形成後其週圍組織存在低灌註狀態，320排低劑量容積CT灌註成像不僅可以顯示腦血腫週圍的繼髮性腦缺血，還可以實現全腦灌註成像以髮現原髮病竈遠隔區域的改變，實現對腦血腫的全麵評估。
목적：탐토320배저제량용적CT관주성상재급성（72 h내）막상자발성뇌혈종형성후계발성뇌결혈중적진단우세급응용개치。방법회고성분석아원2012년7월지2012년12월기간취진적33례급성막상자발성뇌출혈환자적일참식320배저제량용적CT관주성상자료。측량환자뇌혈종변연구、외층구급기경상적관주삼수치，포괄뇌혈류량（CBF）、뇌혈용량（CBV）、평균통과시간（MTT）화최대봉치시간（TTP），병계산각삼수환측/대측적상대치，즉rCBF、rCBV、rMTT급rTTP。채용배대t검험비교급성기뇌혈종변연구、외층구급기경상각삼수적차이，채용배대t검험비교혈종변연구화외층구각삼수상대치적차이。기록소묘시궤기현시적제량장도승적（DLP），DLP승이두부적유효제량계수득도유효복사제량。결과（1）33례뇌출혈환자중，뇌혈종체적최대위94.45 ml，최소위5.72 ml，혈종평균체적위31.75 ml。（2）급성기뇌혈종변연구CBF、CBV、MTT급TTP분별위（16.83±5.89）ml·（100 g）-1·min-1、（1.04±0.41） ml/100 g、（3.70±0.93）s급（20.16±3.07）s，기경상구역대응치분별위（24.18±6.67）ml·（100 g）-1·min-1、（1.71±0.35）ml/100 g、（4.44±0.75）s급（17.74±3.78）s，혈종변연구교경상구역관주감저，CBF、CBV、MTT급TTP대비균유통계학차이（tCBF=-11.223，PCBF<0.01；tCBV=-11.743，PCBV<0.01；tMTT=-4.641，PMTT<0.01급tTTP=5.035，PTTP<0.01）。（3）급성기뇌혈종외층구CBF、CBV、MTT급TTP분별위（24.53±6.97）ml·（100 g）-1·min-1、（1.77±0.38）ml/100 g、（4.51±0.74）s급（17.98±3.49）s，기경상구역대응치분별위（26.09±7.40） ml·（100 g）-1·min-1、（1.85±0.41）ml/100 g、（4.47±0.80）s급（17.63±3.58）s，혈종외층구CBF급TTP여경상구역대비유통계학차이（tCBF=-3.586，PCBF<0.01급tTTP=2.620，PTTP<0.05），단CBV급MTT여경상구역대비무통계학차이（tCBV=-2.007，PCBV>0.05급tMTT=0.662，PMTT>0.05）。（4）급성기뇌혈종변연구rCBF、rCBV、rMTT급rTTP분별위0.70±0.14、0.61±0.20、0.84±0.17급1.16±0.19，외층구관주교변연구개선，대응치분별위0.95±0.10、0.98±0.15、1.02±0.09급1.02±0.05。변연구rCBF、rCBV균교외층구감저，유통계학차이（trCBF＝-8.747，PrCBF<0.01급 trCBV＝-9.057，PrCBV<0.01）；rMTT 교외층구축단（trMTT＝-5.639， PrMTT<0.01）；이rTTP교외층구연장（trTTP＝4.399，PrTTP<0.01）。（5）33례환자중，육안발현10례환자（30%，10/33）량측소뇌반구관주불대칭，기중8례환자（24%，8/33）뇌혈종대측소뇌반구출현관주감저，2례환자（6%，2/33）뇌혈종동측소뇌반구출현관주감저。（6）입조환자두로CT일참식검사DLP위4244.30 mGy，유효복사제량약위9.76 mSv。결론급성막상자발성뇌혈종형성후기주위조직존재저관주상태，320배저제량용적CT관주성상불부가이현시뇌혈종주위적계발성뇌결혈，환가이실현전뇌관주성상이발현원발병조원격구역적개변，실현대뇌혈종적전면평고。
Objective To study the diagnostic advantages and applied value of 320-slice low-dose volume CT perfusion imaging in the secondary cerebral ischemia after acute supratentorial spontaneous intracerebral hematoma formation(within 72 hours). Methods The data of one-stop 320-slice low-dose volume CT perfusion maging in 33 patients of acute supratentorial spontaneous cerebral hemorrhage of our hospital during July 2012 to December 2012 were retrospectively reviewed. The perfusion parameters values of the marginal zone and outer zone of the intracerebral hematoma and their mirror were measured, including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time(MTT)and time-to-peak(TTP), and rCBF, rCBV, rMTT and rTTP were calculated by ipsilateral/contralateral value. The differences of CBF, CBV, MTT and TTP between the marginal zone or the outer zone and the mirror were compared with paired samples t test. The differences of rCBF, rCBV, rMTT and rTTP between the marginal zone and the outer zone were also compared with paired samples t test. The dose-length products(DLP) were recorded during the CT scanning. Effective doses for each examination were calculated using the DLP and normalized values of effective dose per DLP appropriate for the head regions imaged. Results (1)The maximum and minimum of hematoma were 94.45 ml and 5.72 ml respectively, and the mean was 31.75 ml of 33 patients; (2)The CBF, CBV, MTT and TTP of the marginal zone were (16.83±5.89) ml?(100 g)-1?min-1,(1.04±0.41)ml/100 g,(3.70±0.93)s and (20.16±3.07)s respectively and corresponding values of the mirror were (24.18±6.67)ml?(100 g)-1?min-1,(1.71±0.35)ml/100 g,(4.44±0.75)s and (17.74±3.78) s. The marginal zone showed low perfusion than the mirror area and there were significant statistical difference(tCBF=-11.223, PCBF<0.01; tCBV=-11.743, PCBV<0.01; tMTT=-4.641, PMTT<0.01 and tTTP=5.035, PTTP<0.01). (3)The CBF, CBV, MTT and TTP of the outer zone were (24.53±6.97)ml?(100 g)-1?min-1,(1.77±0.38)ml/100 g,(4.51±0.74)s and (17.98±3.49)s respectively and corresponding values of the mirror were (26.09±7.40)ml?(100 g)-1?min-1, (1.85±0.41)ml/100 g,(4.47±0.80)s and (17.63±3.58)s. There were significant statistical difference between the outer zone and the mirror area for the CBF and TTP(tCBF=-3.586, PCBF<0.01 and tTTP=2.620, PTTP<0.05),but there were no statistical difference for the CBV and MTT(tCBV=-2.007, PCBV>0.05 and tMTT=0.662, PMTT>0.05).(4)The rCBF, rCBV, rMTT and rTTP of the marginal zone were 0.70±0.14,0.61±0.20,0.84±0.17 and 1.16±0.19 respectively and corresponding values of the outer zone were 0.95±0.10,0.98±0.15,1.02±0.09 and 1.02±0.05. The perfusion of the outer zone was much better than the marginal zone. rCBF and rCBV in the marginal zone were lower(trCBF=-8.747, PrCBF<0.01 and trCBV=-9.057, PrCBV<0.01 respectively)and there were significant statistical difference. rMTT was shorten(trMTT=-5.639, PrMTT<0.01)than the outer zone,but rTTP were more delayed in the marginal zone(trTTP=4.399, PrTTP<0.01). (5)Perfusion asymmetry of bilateral cerebellar hemisphere was found in 10 patients(30%, 10/33)of total 33 patients for the naked eye. 8 patients (24%, 8/33)showed hypoperfusion in the contralateral cerebellar hemisphere of intracerebral hematoma and 2 patients(6%, 2/33) showed in the ipsilateral cerebellar hemisphere. (6)The total radiation dose of approximately 5-10 mSv for each patient in our study was significantly lower than previous studies. DLP was 4244.30 mGy for one-stop CT examination and the effective doses was 9.76 mSv.Conclusion Hypoperfusion was appeared in perihematomal area of acute supratentorial spontaneous intracerebral hematoma. 320-slice of low-dose and volume CT perfusion imaging not only revealed the secondary cerebral ischemia in perihematomal area, but also achieved whole cerebral perfusion imaging in which had a good display for changes in the distant region of the primary lesion and assessed comprehensively the intracerebral hematoma.
