中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2014年
1期
50-55
,共6页
童秋云%李瑞%陈伟建%杨运俊%林怡%吴楠%王殊%王宏清%许化致
童鞦雲%李瑞%陳偉建%楊運俊%林怡%吳楠%王殊%王宏清%許化緻
동추운%리서%진위건%양운준%림이%오남%왕수%왕굉청%허화치
蛛网膜下腔出血%体层摄影术,X线计算机%灌注%延迟性脑缺血
蛛網膜下腔齣血%體層攝影術,X線計算機%灌註%延遲性腦缺血
주망막하강출혈%체층섭영술,X선계산궤%관주%연지성뇌결혈
Subarachnoid hemorrhage%Tomography,X-ray compated%Perfusion%Delayed cerebral ischemia
目的 比较动脉瘤性蛛网膜下腔出血(aSAH)后24 h内及6～8 d SAH周围脑实质CT灌注变化情况,以探讨CT灌注成像在预测延迟性脑缺血(DCI)中的应用价值.方法 回顾性分析温州医科大学附属第一医院2011年12月至2012年12月期间32例aSAH患者的影像学资料.所有患者发病24 h内均行颅脑CT平扫、CT血管成像(CTA)及CT灌注成像(CTP)一站式检查,发病6～8d复查颅脑CT平扫及CTP.测量患者先、后两次CTP检查低灌注区域或SAH周围及其镜像脑实质区域的灌注参数值,包括脑血流量(CBF)、脑血容量(CBV)及平均通过时间(MTT),计算低灌注区域或SAH周围脑实质及其镜像脑实质区域的各参数比值,获得相对脑血流量(rCBF)、相对脑血容量(rCBV)及相对平均通过时间(rMTT).32例患者根据其有无发生DCI,分为DCI患者组(8例)及非DCI患者组(24例).采用独立样本t检验比较两组之间患者前后两次CTP检查低灌注区域或SAH周围脑实质的rCBF、rCBV及rMTT的差值的差异.结果 DCI组首次检查低灌注区域或SAH周围脑实质的rCBF、rCBV及rMTT分别为1.1±0.3、1.1±0.5及1.1±0.2,复查时对应数值为0.7±0.2、0.9±0.2及1.5±0.3;非DCI组首次检查rCBF、rCBV及rMTT分别为0.9±0.3、1.0±0.2及1.1±0.2,复查时对应数值为0.9±0.2、0.9±0.2及1.1±0.2.DCI组复查与首次检查对比,rCBF降低、rMTT延长,而非DCI组虽部分患者灌注好转,但总体rCBF、rCBV及rMTT变化不明显,两组间复查与首次检查相比,rCBF及rMTT的差值有统计学意义(t rCBF=2.659,P rCBF=0.012;trMTT=-3.747,PrMTT =0.001),但两组间前后两次检查rCBV对比差异无统计学意义(trCBV=1.031,PrCBV =0.311).结论 CTP参数rCBF及rMTT值敏感性较高,对预测DCI的发生有重要意义,有利于临床诊疗方案的制定.
目的 比較動脈瘤性蛛網膜下腔齣血(aSAH)後24 h內及6～8 d SAH週圍腦實質CT灌註變化情況,以探討CT灌註成像在預測延遲性腦缺血(DCI)中的應用價值.方法 迴顧性分析溫州醫科大學附屬第一醫院2011年12月至2012年12月期間32例aSAH患者的影像學資料.所有患者髮病24 h內均行顱腦CT平掃、CT血管成像(CTA)及CT灌註成像(CTP)一站式檢查,髮病6～8d複查顱腦CT平掃及CTP.測量患者先、後兩次CTP檢查低灌註區域或SAH週圍及其鏡像腦實質區域的灌註參數值,包括腦血流量(CBF)、腦血容量(CBV)及平均通過時間(MTT),計算低灌註區域或SAH週圍腦實質及其鏡像腦實質區域的各參數比值,穫得相對腦血流量(rCBF)、相對腦血容量(rCBV)及相對平均通過時間(rMTT).32例患者根據其有無髮生DCI,分為DCI患者組(8例)及非DCI患者組(24例).採用獨立樣本t檢驗比較兩組之間患者前後兩次CTP檢查低灌註區域或SAH週圍腦實質的rCBF、rCBV及rMTT的差值的差異.結果 DCI組首次檢查低灌註區域或SAH週圍腦實質的rCBF、rCBV及rMTT分彆為1.1±0.3、1.1±0.5及1.1±0.2,複查時對應數值為0.7±0.2、0.9±0.2及1.5±0.3;非DCI組首次檢查rCBF、rCBV及rMTT分彆為0.9±0.3、1.0±0.2及1.1±0.2,複查時對應數值為0.9±0.2、0.9±0.2及1.1±0.2.DCI組複查與首次檢查對比,rCBF降低、rMTT延長,而非DCI組雖部分患者灌註好轉,但總體rCBF、rCBV及rMTT變化不明顯,兩組間複查與首次檢查相比,rCBF及rMTT的差值有統計學意義(t rCBF=2.659,P rCBF=0.012;trMTT=-3.747,PrMTT =0.001),但兩組間前後兩次檢查rCBV對比差異無統計學意義(trCBV=1.031,PrCBV =0.311).結論 CTP參數rCBF及rMTT值敏感性較高,對預測DCI的髮生有重要意義,有利于臨床診療方案的製定.
목적 비교동맥류성주망막하강출혈(aSAH)후24 h내급6～8 d SAH주위뇌실질CT관주변화정황,이탐토CT관주성상재예측연지성뇌결혈(DCI)중적응용개치.방법 회고성분석온주의과대학부속제일의원2011년12월지2012년12월기간32례aSAH환자적영상학자료.소유환자발병24 h내균행로뇌CT평소、CT혈관성상(CTA)급CT관주성상(CTP)일참식검사,발병6～8d복사로뇌CT평소급CTP.측량환자선、후량차CTP검사저관주구역혹SAH주위급기경상뇌실질구역적관주삼수치,포괄뇌혈류량(CBF)、뇌혈용량(CBV)급평균통과시간(MTT),계산저관주구역혹SAH주위뇌실질급기경상뇌실질구역적각삼수비치,획득상대뇌혈류량(rCBF)、상대뇌혈용량(rCBV)급상대평균통과시간(rMTT).32례환자근거기유무발생DCI,분위DCI환자조(8례)급비DCI환자조(24례).채용독립양본t검험비교량조지간환자전후량차CTP검사저관주구역혹SAH주위뇌실질적rCBF、rCBV급rMTT적차치적차이.결과 DCI조수차검사저관주구역혹SAH주위뇌실질적rCBF、rCBV급rMTT분별위1.1±0.3、1.1±0.5급1.1±0.2,복사시대응수치위0.7±0.2、0.9±0.2급1.5±0.3;비DCI조수차검사rCBF、rCBV급rMTT분별위0.9±0.3、1.0±0.2급1.1±0.2,복사시대응수치위0.9±0.2、0.9±0.2급1.1±0.2.DCI조복사여수차검사대비,rCBF강저、rMTT연장,이비DCI조수부분환자관주호전,단총체rCBF、rCBV급rMTT변화불명현,량조간복사여수차검사상비,rCBF급rMTT적차치유통계학의의(t rCBF=2.659,P rCBF=0.012;trMTT=-3.747,PrMTT =0.001),단량조간전후량차검사rCBV대비차이무통계학의의(trCBV=1.031,PrCBV =0.311).결론 CTP삼수rCBF급rMTT치민감성교고,대예측DCI적발생유중요의의,유리우림상진료방안적제정.
Objective To study cerebral perfusion in surroundin gbrain parenchyma within 24 hours and 6-8 days after aneurysmal subarachnoid hemorrhage (aSAH) by CT perfusion imaging,to explore the applied value of CT perfusion imaging in predicting delayed cerebral ischemia (DCI).Methods Imaging data of 32 consecutive aSAH patients of our hospital during December 2011 to December 2012 were retrospectively reviewed.All patients underwent non-contrast CT,CT angiography (CTA) and CT perfusion (CTP) imaging within 24 hours of onset.6-8 days after SAH,only non-contrast CT and CTP could be performed.The perfusion parameters values in hypoperfusion area or surrounding brain parenchyma of SAH and the mirror parenchyma were measured for the first and follow-up CTP,including cerebral blood flow (CBF),cerebral blood volume (CBV),mean transit time (MTT).To calculate the ratio of the two parts to get the relative cerebral blood flow(rCBF),relative cerebral blood volume (rCBV) and relative mean transit time (rMTT).According to presence of DCI,32 patients were divided into DCI group (8 patients) and no-DCI group(24 patients).The differences of rCBF、rCBV and rMTT of the two examination between the two group were compared with independent-sample t test.Results For the DCI group,rCBF was 1.0 ± 0.3、rCBV was 1.1 ±0.5 and rMTT was 1.1 ±0.2 in the first CTP,rCBF was 0.7 ±0.2、rCBV was 0.9 ±0.2 and rMTT was 1.5 ±0.3 in the follow-up CTP.For the no-DCI group,rCBF was0.9 ±0.3 、rCBV was 1.0 ±0.2 and rMTT was1.1 ±0.2 in the first CTP,rCBF was 0.9 ±0.2、rCBV was 0.9 ±0.2 and rMTT was 1.1 ± 0.2 in the follow-up CTP.Compared with the first CTP,there was lower rCBF、stable rCBV and higher rMTT in the follow-up CTP for the DCI group.Although perfusion was improved in some patients,but there were no significant changes overall for the rCBF、rCBV and rMTT for the twice CTP.There was significant statistical difference in the differences of rCBF and rMTT of the two examination between the two group (t rCBF =2.659,P rCBF =0.012 ; t rMTT =--3.747,P rCBF =0.001).But there were no significant statistical difference in rCBV of the two examination between the two group (t rCBv =1.031,P rCBF =0.311).Conclusion The CTP parameters of rCBF and rMTT has higher sensitivity and is important to predict the occurrnce of the DCI.
