CAJ | 학술논문

目的经颅多普勒(TCD)联合CT灌注成像(CrP)对单侧颈内动脉(ICA)重度狭窄或闭塞患者脑血流动力学评价.方法经TCD检测为单侧ICA重度狭窄或闭塞患者19例,分症状组(9例)及无症状组(10例),行头颅CT血管成像(CTA)和CTP检查.15例健康志愿者为对照组.比较症状组和无症状组患侧之间、症状组和无症状组患侧与对照组TCD及CTP参数.结果 TCD示症状组患侧大脑中动脉(MCA)平均血流速度(Vm)低于对照组(P＜0.001),而无症状组MCA Vm低于对照组,但差异无统计学意义(P＞0.05)；症状组和无症状组MCA搏动指数(PI)均低于对照组(P＜0.05).症状组患侧MCA Vm明显低于无症状组(P ＜0.001),与颅内侧枝循环有关.症状组和无症状组与对照组CTP参数分析,症状组患侧脑血流量(CBF)减低(P＜0.05),而无症状组CBF无明显改变(P＞0.05)；症状组和无症状组平均通过时间(MTI)及达峰时间(TIP)延长(P＜0.05),但两组脑血容量(CBV)与对照组比较差异无统计学意义(P＞0.05).结论 TCD与CTP结果有良好的一致性,二者联合应用可以综合评估单侧颈动脉狭窄或闭塞患者脑灌注情况,为临床选择有效治疗方案提供科学依据.
목적 경로다보륵(TCD)연합CT관주성상(CrP)대단측경내동맥(ICA)중도협착혹폐새환자뇌혈류동역학평개.방법 경TCD검측위단측ICA중도협착혹폐새환자19례,분증상조(9례)급무증상조(10례),행두로CT혈관성상(CTA)화CTP검사.15례건강지원자위대조조.비교증상조화무증상조환측지간、증상조화무증상조환측여대조조TCD급CTP삼수.결과 TCD시증상조환측대뇌중동맥(MCA)평균혈류속도(Vm)저우대조조(P＜0.001),이무증상조MCA Vm저우대조조,단차이무통계학의의(P＞0.05)；증상조화무증상조MCA박동지수(PI)균저우대조조(P＜0.05).증상조환측MCA Vm명현저우무증상조(P ＜0.001),여로내측지순배유관.증상조화무증상조여대조조CTP삼수분석,증상조환측뇌혈류량(CBF)감저(P＜0.05),이무증상조CBF무명현개변(P＞0.05)；증상조화무증상조평균통과시간(MTI)급체봉시간(TIP)연장(P＜0.05),단량조뇌혈용량(CBV)여대조조비교차이무통계학의의(P＞0.05).결론 TCD여CTP결과유량호적일치성,이자연합응용가이종합평고단측경동맥협착혹폐새환자뇌관주정황,위림상선택유효치료방안제공과학의거.
Objective Transcranial Doppler (TCD) combined with whole-brain CT perfusion (CTP) to evaluate cerebral hemodynamics in patients with unilateral internal carotid artery severe stenosis or occlusion.Methods 19 patients with unilateral internal carotid artery (ICA) severe stenosis or occlusion detected by TCD were divided into the symptonatic group and asymptomatic group.All the cases underwent CT angiography (CTA) and CTP examination.15 volunteers made up the control group.The blood flow parameters obtained by TCD and CTP at the stenotic or occlusive side were compared between the two groups and with those of the control group.Results The mean blood flow velocity (Vm) of middle cerebral artery (MCA) ipsilateral to the severe stenosis or occlusion measured by TCD in both groups were lower than the control group.As for the symptomatic group,the difference was significant (P ＜0.001),while it was not for the asymptomatic group (P ＞0.05).The pulsatility index (PI) of MCA ipsilateral to the severe stenosis or occlusion of both groups were lower than that of the control group (P ＜0.05).MCA Vm of the symptomatic group was lower than that of the asymptomatic group,which was correlated with collateral circulation.Compared with the control group,the cerebral blood flow (CBF) at the side of the severe stenosis or occlusion of the symptomatic group by CTP decreased significantly (P ＜0.05),whereas that of the asymptomatic group did not change obviously (P ＞0.05).Compared with the control group,mean transit time (MTT) as well as time to peak (TTP) of both groups were longer (P ＜0.05),while cerebral blood volume (CBV) of both groups were not significantly different (P ＞ 0.05).Conclusions TCD and CTP findings had good consistency.Combination of the two could synthetically assess cerebral perfusion in patients with unilateral ICA stenosis or occlusion,which may help to provide scientific basis for effective chnical treatment.