CAJ | 학술논문

目的探讨能谱计算机断层扫描(computed tomography,CT)容积螺旋穿梭扫描技术在烟雾病患者血管和灌注成像中的应用价值.方法对4例术前、11例术后的烟雾病患者行容积螺旋穿梭扫描检查,获得四维CT血管成像及全脑CT灌注成像.采用CT平扫分型、颈内动脉分期、侧支循环分类、烟雾状血管丰富程度分期、CT灌注异常分期及Alberta卒中早期CT评分的评估标准,分左右大脑半球综合评价烟雾病的脑实质和脑血管病变.结果术前4例烟雾病患者,8个半球中的5个半球(62.5%)处于颈内动脉分期的I I期;本组侧支循环主要来源于颅底血管网(46.1%);梗死分期中,8个半球(100%)出现异常,其中7个半球(87.5%)处于梗死前期的Ⅱ期,且Alberta卒中早期CT评分均在10分以上.术后11例(22个半球)患者均行颞浅动脉-大脑中动脉搭桥术,其中左侧6例,右侧4例,双侧1例,吻合血管通畅率为100%;梗死分期中19个半球(86.4%)出现异常,其中10个半球(45.5%)处于I期、8个半球(36.4%)处于Ⅲ期.结论能谱CT容积螺旋穿梭技术可以同时获得四维CT血管成像及全脑CT灌注成像,能对判断烟雾病患者的动脉分期、侧支循环、脑灌注情况、术后血管吻合等影像学信息发挥重要作用.
목적탐토능보계산궤단층소묘(computed tomography,CT)용적라선천사소묘기술재연무병환자혈관화관주성상중적응용개치.방법대4례술전、11례술후적연무병환자행용적라선천사소묘검사,획득사유CT혈관성상급전뇌CT관주성상.채용CT평소분형、경내동맥분기、측지순배분류、연무상혈관봉부정도분기、CT관주이상분기급Alberta졸중조기CT평분적평고표준,분좌우대뇌반구종합평개연무병적뇌실질화뇌혈관병변.결과술전4례연무병환자,8개반구중적5개반구(62.5%)처우경내동맥분기적I I기;본조측지순배주요래원우로저혈관망(46.1%);경사분기중,8개반구(100%)출현이상,기중7개반구(87.5%)처우경사전기적Ⅱ기,차Alberta졸중조기CT평분균재10분이상.술후11례(22개반구)환자균행섭천동맥-대뇌중동맥탑교술,기중좌측6례,우측4례,쌍측1례,문합혈관통창솔위100%;경사분기중19개반구(86.4%)출현이상,기중10개반구(45.5%)처우I기、8개반구(36.4%)처우Ⅲ기.결론능보CT용적라선천사기술가이동시획득사유CT혈관성상급전뇌CT관주성상,능대판단연무병환자적동맥분기、측지순배、뇌관주정황、술후혈관문합등영상학신식발휘중요작용.
Objective To investigate the value of spectral computed tomography(CT) volume shuttle scanning technique in assessment of vascular status and perfusion in patients with moyamoya disease. Methods Spiral CT volume shuttle scanning was performed in 4 preoperative cases and 11 postoperative cases with moyamoya disease, to obtain four dimensional computed tomography angiography(CTA) and whole brain CT perfusion images. The evaluation standards of noncontrast CT classification, internal carotid artery stage, collateral circulation classification, rich puff-like network stage, abnormal CT perfusion stage and Alberta Stroke Program Early CT Score were applied to analyze cerebral parenchyma and vascular lesions of moyamoya disease in left and right cerebral hemispheres. Results In 4 preoperative patients(8 hemispheres) with moyamoya disease, 5(62.5%) of 8 hemispheres were in stage Ⅲ of internal carotid artery stage. In this group, the collateral circulation(46.1%) mainly originated from skull base vascular network. In addition, 8 hemispheres(100%) appeared abnormal on computed tomography perfusion(CTP), 7 of which(87.5%) were in pre-infarction stage II, and had Alberta Stroke Program Early CT Score more than 10 points at the same time. In 11 cases(22 hemispheres) who underwent superficial temporal artery to middle cerebral artery bypass, 6 were performed on the left, 4 were completed on the right and 1 were double,whereas the bypass patency rate was 100%. Moreover, the infarction stage of 19 hemispheres(86.4%) were abnormal, in which 40.1%(9/22) wereⅡstage and 36.4%(8/22) wereⅢstage, respectively. Conclusion Four dimensional CT angiography and whole brain CT perfusion are obtained by spectral CT volume shuttle scanning technology. The images have great values for the assessment of internal carotid artery stage, collateral circulation, graft patency and cerebral hemodynamics changes postoperatively.