CAJ | 학술논문

目的：通过对单侧颈内动脉重度狭窄或闭塞患者行脑CT灌注成像联合CTA一站式扫描，对其脑血流动力学改变及 Willis环侧支循环代偿作用进行评价，为临床血管再通治疗提供血流动力学依据。方法：对40例经颈部血管超声或头颈CTA检查确定为单侧颈内动脉重度狭窄或闭塞患者（狭窄率＞70％）行320排 CTPI 检查，重建灌注参数图及4D-CTA图。在基底节层面选取大脑前动脉供血区、大脑中动脉供血区及前、后分水岭区作为感兴趣区行灌注参数测量，包括脑血容量（CBV）、脑血流量（CBF）、平均通过时间（MTT）和达峰时间（TTP），对患侧与健侧的各项灌注参数进行对比分析。根据CTA图将 Willis环分为开放组及未开放组，对两组的dTTP（患侧TTP-健侧TTP）、dMTT、rCBF（患侧CBF／健侧CBF）及rCBV进行比较，采用χ2检验对比分析两组间各个兴趣区的缺血程度（rCBF＜80％为重度，＞80％为轻度），评价 Willis的代偿能力。结果：与健侧比较，患侧脑区 MTT、TTP 延长，CBV 增大，CBF 略下降，其中在大脑中动脉供血区和前、后分水岭区CBV、MTT、TTP差异有统计学意义（P＜0．05），大脑前动脉供血区 MTT、TTP 差异有统计学意义（P＜0．05）。Willis环未开放组各兴趣区 dTTP、dMTT、rCBV 和 rCBF 均高于开放组。仅前分水岭区的脑缺血程度与Willis环是否开放有相关关系（P＝0．001）。结论：单侧颈内动脉重度狭窄及闭塞患者的患侧脑组织 MTT、TTP 延长，部分脑区CBF下降，处于低灌注状态；Willis环对患侧有一定的代偿作用，在前分水岭区代偿作用明显；CTPI可以为颈内动脉重度狭窄或闭塞患者提供血管再通依据。
목적：통과대단측경내동맥중도협착혹폐새환자행뇌CT관주성상연합CTA일참식소묘，대기뇌혈류동역학개변급 Willis배측지순배대상작용진행평개，위림상혈관재통치료제공혈류동역학의거。방법：대40례경경부혈관초성혹두경CTA검사학정위단측경내동맥중도협착혹폐새환자（협착솔＞70％）행320배 CTPI 검사，중건관주삼수도급4D-CTA도。재기저절층면선취대뇌전동맥공혈구、대뇌중동맥공혈구급전、후분수령구작위감흥취구행관주삼수측량，포괄뇌혈용량（CBV）、뇌혈류량（CBF）、평균통과시간（MTT）화체봉시간（TTP），대환측여건측적각항관주삼수진행대비분석。근거CTA도장 Willis배분위개방조급미개방조，대량조적dTTP（환측TTP-건측TTP）、dMTT、rCBF（환측CBF／건측CBF）급rCBV진행비교，채용χ2검험대비분석량조간각개흥취구적결혈정도（rCBF＜80％위중도，＞80％위경도），평개 Willis적대상능력。결과：여건측비교，환측뇌구 MTT、TTP 연장，CBV 증대，CBF 략하강，기중재대뇌중동맥공혈구화전、후분수령구CBV、MTT、TTP차이유통계학의의（P＜0．05），대뇌전동맥공혈구 MTT、TTP 차이유통계학의의（P＜0．05）。Willis배미개방조각흥취구 dTTP、dMTT、rCBV 화 rCBF 균고우개방조。부전분수령구적뇌결혈정도여Willis배시부개방유상관관계（P＝0．001）。결론：단측경내동맥중도협착급폐새환자적환측뇌조직 MTT、TTP 연장，부분뇌구CBF하강，처우저관주상태；Willis배대환측유일정적대상작용，재전분수령구대상작용명현；CTPI가이위경내동맥중도협착혹폐새환자제공혈관재통의거。
Objective:To evaluate the hemodynamic change and collateral compensatory effect of Willis circle by ap-plying brain CT perfusion combined with CT angiography in patients with severe stenosis or occlusion of unilateral internal carotid artery,this is to provide hemodynamic basis for vascular recanalization treatment.Methods:40 patients underwent whole brain 320-slice dynamic volume CT scan,and perfusion parameters maps and 4D-CTA images were calculated.Perfu-sion parameters were recorded and compared,including cerebral blood volume (CBV),cerebral blood flow (CBF),mean transit time (MTT)and time of peak time (TTP).In the basal ganglia level,anterior cerebral artery,middle cerebral artery, anterior and posterior watershed area were selected as areas of interest.Paired t test was used to analyze the means of the affected brain tissue and the contralateral corresponding parts of the brain tissue.According to the CTA images,Willis's cir-cle was divided into open group and closed group.In this two groups,dTTP (TTP with affected side-the contralateral side), dMTT (MTT with affected side-the contralateral side),rCBF (CBF on affected side/contralateral CBF)and rCBV (CBV on affected side/contralateral CBV)were compared.Ischemic level of the two groups were measured and compared by usingχ2-test,in order to evaluate compensatory ability of Willis's circle.Results:Compared with the control group,MTT and TTP delayed,CBV increased,CBF slightly decreased.Compared with the control group,in middle cerebral artery,anterior and an-terior watershed areas,CBV,MTT and TTP showed significant difference (P<0.05);In anterior cerebral artery area, MTT,TTP showed significant difference (P<0.05).Compared with Willis circle open group and closed group,dTTP and dMTT increased,rCBV and rCBF slightly lowered.Only in anterior watershed area,there was statistically significant diffe-rence in the ischemic level between the two groups.Conclusion:Ipsilateral brain tissue of patients with severe stenosis or oc-clusion of unilateral internal carotid artery had prolonged MTT and TTP,decreased CBF as well as hypo-perfusion state;Willis circle has certain compensatory effect on the affected side,especially in the anterior watershed area.CTP can provide basis of vascular recanalization for patients with severe stenosis or occlusion of unilateral internal carotid artery.