CAJ | 학술논문

目的：应用320排容积CT灌注成像（CTPI）研究亚急性期高血压性脑出血（HICH）后周围组织的血流动力学变化。方法：对21例HICH患者于发病后4～14d行CTPI检查，测量脑血肿体积、脑血肿周围（边缘区、外层区）及对侧镜像区的脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）及达峰时间（TTP），并计算相对灌注参数值rCBF、rCBV、rMTT及rTTP（患侧/健侧）。采用成组t检验对边缘区、外层区及其相应镜像区域各参数值、边缘区、外层区相对灌注参数值进行分析；采用Pearson相关性分析血肿体积、发病时间与血肿周围（边缘区及外层区）rCBF、rCBV、rMTT及rTTP的相关性。结果：亚急性期脑血肿边缘区CBF、CBV均较对侧镜像区降低，差异有统计学意义（tCBF=-4.442，PCBF＜0.01；tCBV=-4.139，PCBV＜0.01），TTP较镜像区显著延长，差异有统计学意义（tTTP=4.030，PTTP＜0.01），MTT较镜像区有所缩短，差异无统计学意义（tMTT=-1.631，PMTT＞0.05）。血肿外层区CBF较镜像区减低，差异有统计学意义（tCBF=-2.196，PCBF＜0.05）， MTT较镜像区延长，差异有统计学意义（tMTT=2.093，PMTT＜0.05），CBV及TTP与镜像区对比，差异无统计学意义（tCBV＝-0.776，PCBV＞0.05；tTTP＝0.336，PTTP＞0.05）。血肿边缘区rCBF、rCBV均较外层区减低，差异有统计学意义（trCBF＝-2.688，PrCBF＜0.05；trCBV＝-3.124，PrCBV＜0.01）；rMTT较外层区缩短，差异有统计学意义（trMTT＝-2.770，PrMTT＜0.05）；而rTTP较外层区延长，差异有统计学意义（trTTP＝3.574，PrTTP＜0.01）。血肿体积与血肿周围rCBF、rCBV、rMTT及血肿外层区rTTP均无显著相关性，与血肿边缘区rTTP有相关性（r=0.472， P＜0.05）。发病时间与血肿周围（边缘区和外层区）rCBF、rCBV、rMTT及血肿边缘区rTTP无显著相关性，与血肿外层区rTTP有相关性（r=0.441，P＜0.05）。结论：亚急性期HICH血肿周围存在脑灌注减低，且血肿周围rCBF、rCBV与血肿体积、发病时间无明显相关。目的：應用320排容積CT灌註成像（CTPI）研究亞急性期高血壓性腦齣血（HICH）後週圍組織的血流動力學變化。方法：對21例HICH患者于髮病後4～14d行CTPI檢查，測量腦血腫體積、腦血腫週圍（邊緣區、外層區）及對側鏡像區的腦血流量（CBF）、腦血容量（CBV）、平均通過時間（MTT）及達峰時間（TTP），併計算相對灌註參數值rCBF、rCBV、rMTT及rTTP（患側/健側）。採用成組t檢驗對邊緣區、外層區及其相應鏡像區域各參數值、邊緣區、外層區相對灌註參數值進行分析；採用Pearson相關性分析血腫體積、髮病時間與血腫週圍（邊緣區及外層區）rCBF、rCBV、rMTT及rTTP的相關性。結果：亞急性期腦血腫邊緣區CBF、CBV均較對側鏡像區降低，差異有統計學意義（tCBF=-4.442，PCBF＜0.01；tCBV=-4.139，PCBV＜0.01），TTP較鏡像區顯著延長，差異有統計學意義（tTTP=4.030，PTTP＜0.01），MTT較鏡像區有所縮短，差異無統計學意義（tMTT=-1.631，PMTT＞0.05）。血腫外層區CBF較鏡像區減低，差異有統計學意義（tCBF=-2.196，PCBF＜0.05）， MTT較鏡像區延長，差異有統計學意義（tMTT=2.093，PMTT＜0.05），CBV及TTP與鏡像區對比，差異無統計學意義（tCBV＝-0.776，PCBV＞0.05；tTTP＝0.336，PTTP＞0.05）。血腫邊緣區rCBF、rCBV均較外層區減低，差異有統計學意義（trCBF＝-2.688，PrCBF＜0.05；trCBV＝-3.124，PrCBV＜0.01）；rMTT較外層區縮短，差異有統計學意義（trMTT＝-2.770，PrMTT＜0.05）；而rTTP較外層區延長，差異有統計學意義（trTTP＝3.574，PrTTP＜0.01）。血腫體積與血腫週圍rCBF、rCBV、rMTT及血腫外層區rTTP均無顯著相關性，與血腫邊緣區rTTP有相關性（r=0.472， P＜0.05）。髮病時間與血腫週圍（邊緣區和外層區）rCBF、rCBV、rMTT及血腫邊緣區rTTP無顯著相關性，與血腫外層區rTTP有相關性（r=0.441，P＜0.05）。結論：亞急性期HICH血腫週圍存在腦灌註減低，且血腫週圍rCBF、rCBV與血腫體積、髮病時間無明顯相關。
목적：응용320배용적CT관주성상（CTPI）연구아급성기고혈압성뇌출혈（HICH）후주위조직적혈류동역학변화。방법：대21례HICH환자우발병후4～14d행CTPI검사，측량뇌혈종체적、뇌혈종주위（변연구、외층구）급대측경상구적뇌혈류량（CBF）、뇌혈용량（CBV）、평균통과시간（MTT）급체봉시간（TTP），병계산상대관주삼수치rCBF、rCBV、rMTT급rTTP（환측/건측）。채용성조t검험대변연구、외층구급기상응경상구역각삼수치、변연구、외층구상대관주삼수치진행분석；채용Pearson상관성분석혈종체적、발병시간여혈종주위（변연구급외층구）rCBF、rCBV、rMTT급rTTP적상관성。결과：아급성기뇌혈종변연구CBF、CBV균교대측경상구강저，차이유통계학의의（tCBF=-4.442，PCBF＜0.01；tCBV=-4.139，PCBV＜0.01），TTP교경상구현저연장，차이유통계학의의（tTTP=4.030，PTTP＜0.01），MTT교경상구유소축단，차이무통계학의의（tMTT=-1.631，PMTT＞0.05）。혈종외층구CBF교경상구감저，차이유통계학의의（tCBF=-2.196，PCBF＜0.05）， MTT교경상구연장，차이유통계학의의（tMTT=2.093，PMTT＜0.05），CBV급TTP여경상구대비，차이무통계학의의（tCBV＝-0.776，PCBV＞0.05；tTTP＝0.336，PTTP＞0.05）。혈종변연구rCBF、rCBV균교외층구감저，차이유통계학의의（trCBF＝-2.688，PrCBF＜0.05；trCBV＝-3.124，PrCBV＜0.01）；rMTT교외층구축단，차이유통계학의의（trMTT＝-2.770，PrMTT＜0.05）；이rTTP교외층구연장，차이유통계학의의（trTTP＝3.574，PrTTP＜0.01）。혈종체적여혈종주위rCBF、rCBV、rMTT급혈종외층구rTTP균무현저상관성，여혈종변연구rTTP유상관성（r=0.472， P＜0.05）。발병시간여혈종주위（변연구화외층구）rCBF、rCBV、rMTT급혈종변연구rTTP무현저상관성，여혈종외층구rTTP유상관성（r=0.441，P＜0.05）。결론：아급성기HICH혈종주위존재뇌관주감저，차혈종주위rCBF、rCBV여혈종체적、발병시간무명현상관。
Objective: To study the perihematomal hemodynamics changes in patients with subacute hypertensive intracerebral hemorrhage using 320-row volume CT perfusion imaging. Methods:CTPI was per-formed in twenty-one patients from 4 days to 14 days after the onset of HICH. The volume of the hematomas was measured, and the perfusion parameter values of the marginal zone and outer zone of the intracerebral he-matoma and contralateral mirror were measured, including cerebral blood lfow (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 perfusion parameter values between the marginal zone or the outer zone and the mirror area, and the differences of relative perfusion parameters values between marginal and outer zone were analyzed by paired samples t test. Relationships between the volume of hematomas and the time from the onset to the CTPI performance and rCBF, rCBV, rMTT and rTTP of marginal and outer area were analyzed by Pearson correlation analysis. Results:①Compared with the mirror area, the CBF and CBV of the marginal zone showed lower perfusion and there was signiifcant statistical difference (tCBF=-4.442, PCBF<0.01;tCBF=-4.139, PCBV<0.01), the TTP was more delayed in the marginal zone, and there was signiifcant statistical dif-ference (tTTP=4.030, PTTP<0.01), and the MTT of marginal zone was shorter but there was no signiifcant statistical difference (tMTT=-1.631, PMTT>0.05);The CBF of the outer zone presented lower perfusion than the mirror area and there was signiifcant statistical difference (tCBF=-2.196, PCBF<0.05), MTT was longer than that of the mirror area, there was signiifcant statistical difference (tMTT=-2.093, PMTT<0.05), and there was no statistically differ-ence between the CBV or TTP of outer and mirror area (tCBV=-0.776, PCBV>0.05 and tTTP=0.336, PTTP>0.05). The rCBF and rCBV in the marginal zone were lower than those in the outer zone, and there was signiifcant statistical difference (trCBF=-2.688, PrCBF<0.05 and trCBV=-3.124, PrCBV<0.01 respectively). rMTT was signiifcantly shorter (trMTT=-2.770, PrMTT<0.05) than it in the outer zone, but rTTP was more delayed in the marginal zone (trTTP=3.574, PrTTP<0.01). ②There was no significant relationship between the volume of subacute hematomas and rCBF, rCBV, rMTT of the marginal zone and the outer zone or rTTP of the outer zone, and there was signiifcant rela-tionship between that and rTTP of the marginal zone. There was also no signiifcant relationship between the time from onset to the CTPI performance and rCBF, rCBV, rMTT of the marginal zone or the outer zone and rTTP of the marginal zone, and there was signiifcant relationship between that and rTTP of the outer zone (r=0.441, P<0.05). Conclusion:Hypoperfusion still remained in perihematomal region of subacute hypertensive intracere-bral hematoma, furthermore there is no signiifcant correlation between rCBF and rCBV of perihematoma and the volume of hematoma and the time from onset to CPTI performance.