中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
43期
3514-3518
,共5页
匡祎%陈伟建%郑葵葵%付军%胡子龙%杨运俊%戴一川
劻祎%陳偉建%鄭葵葵%付軍%鬍子龍%楊運俊%戴一川
광의%진위건%정규규%부군%호자룡%양운준%대일천
脑出血%体层摄影术,X线计算机%脑水肿
腦齣血%體層攝影術,X線計算機%腦水腫
뇌출혈%체층섭영술,X선계산궤%뇌수종
Cerebral hemorrhage%Tomography,X-ray computed%Brain edema
目的 应用320排低剂量容积CT灌注成像研究幕上急性(72 h以内)自发性脑出血后周围组织的血流动力学变化.方法 2012年12月至2013年12月温州医科大学附属第一医院对26例(男15例,女11例,年龄30～79岁,平均年龄55.7岁)CT平扫确诊为急性幕上自发性脑出血的患者行CT灌注成像(CTPI)检查.以血肿的最大层面为参照,测量脑血肿周围(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),用自带软件手动测量血肿体积及血肿周围灌注缺损面积,CT平扫图上最大血肿层面手动测量水肿面积.结果 26例急性期血肿边缘区CBF、CBV较对侧镜像区减低(tCBF=-8.125、tCBV=-8.671,PCBF、CBV＜0.01);MTT较对侧镜像区缩短(tMTT=-3.246,PMTT＜0.05);TTP较对侧镜像区延长(tTTP=5.027,PTTP＜0.01).血肿外层区CBV较对侧镜像区减低(tCBV=-2.337,PCBV ＜0.05);MTT较对侧镜像区缩短(tMTT=-2.421,PMTT＜0.05);TTP较对侧镜像区延长(tTTP=2.077,PTTP＜0.05);CBF与对侧镜像区对比差异无统计学意义(tCBF=-1.658,PCBV ＞0.05).急性期血肿边缘区rCBF、rCBV低于外层区(trCBF=-8.816,PCBF＜0.01及trCBV=-6.510,PrCBV ＜0.01);血肿边缘区rTTP较外层区延长(trTP=4.204,PrTTP ＜0.01).血肿体积与血肿边缘区rCBV、rMTT呈直线负相关,与rTTP呈直线正相关(rCBV=-0.412,PrCBV ＜0.05,rrMTT=-0.437,PrMTT＜0.05,rrTTP=0.475,PrTTP＜ 0.05);血肿体积与血肿周围CBF灌注缺损面积呈直线正相关(r =0.440,P＜0.05).最大血肿层面周围水肿面积与血肿体积、血肿周围CBF灌注缺损面积呈直线正相关(r =0.400,r=0.815,P＜0.05).结论 320排低剂量容积CT灌注成像能够较好的反映急性幕上自发性脑出血后周围组织的血流动力学变化;血肿周边存在明显的低灌注区,且与血肿的体积相关;血肿占位效应、血肿周围组织缺血是引起急性期脑水肿形成的重要原因.
目的 應用320排低劑量容積CT灌註成像研究幕上急性(72 h以內)自髮性腦齣血後週圍組織的血流動力學變化.方法 2012年12月至2013年12月溫州醫科大學附屬第一醫院對26例(男15例,女11例,年齡30～79歲,平均年齡55.7歲)CT平掃確診為急性幕上自髮性腦齣血的患者行CT灌註成像(CTPI)檢查.以血腫的最大層麵為參照,測量腦血腫週圍(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),用自帶軟件手動測量血腫體積及血腫週圍灌註缺損麵積,CT平掃圖上最大血腫層麵手動測量水腫麵積.結果 26例急性期血腫邊緣區CBF、CBV較對側鏡像區減低(tCBF=-8.125、tCBV=-8.671,PCBF、CBV＜0.01);MTT較對側鏡像區縮短(tMTT=-3.246,PMTT＜0.05);TTP較對側鏡像區延長(tTTP=5.027,PTTP＜0.01).血腫外層區CBV較對側鏡像區減低(tCBV=-2.337,PCBV ＜0.05);MTT較對側鏡像區縮短(tMTT=-2.421,PMTT＜0.05);TTP較對側鏡像區延長(tTTP=2.077,PTTP＜0.05);CBF與對側鏡像區對比差異無統計學意義(tCBF=-1.658,PCBV ＞0.05).急性期血腫邊緣區rCBF、rCBV低于外層區(trCBF=-8.816,PCBF＜0.01及trCBV=-6.510,PrCBV ＜0.01);血腫邊緣區rTTP較外層區延長(trTP=4.204,PrTTP ＜0.01).血腫體積與血腫邊緣區rCBV、rMTT呈直線負相關,與rTTP呈直線正相關(rCBV=-0.412,PrCBV ＜0.05,rrMTT=-0.437,PrMTT＜0.05,rrTTP=0.475,PrTTP＜ 0.05);血腫體積與血腫週圍CBF灌註缺損麵積呈直線正相關(r =0.440,P＜0.05).最大血腫層麵週圍水腫麵積與血腫體積、血腫週圍CBF灌註缺損麵積呈直線正相關(r =0.400,r=0.815,P＜0.05).結論 320排低劑量容積CT灌註成像能夠較好的反映急性幕上自髮性腦齣血後週圍組織的血流動力學變化;血腫週邊存在明顯的低灌註區,且與血腫的體積相關;血腫佔位效應、血腫週圍組織缺血是引起急性期腦水腫形成的重要原因.
목적 응용320배저제량용적CT관주성상연구막상급성(72 h이내)자발성뇌출혈후주위조직적혈류동역학변화.방법 2012년12월지2013년12월온주의과대학부속제일의원대26례(남15례,녀11례,년령30～79세,평균년령55.7세)CT평소학진위급성막상자발성뇌출혈적환자행CT관주성상(CTPI)검사.이혈종적최대층면위삼조,측량뇌혈종주위(변연구、외층구)급대측경상구적뇌혈류량(CBF)、뇌혈용량(CBV)、평균통과시간(MTT)급체봉시간(TTP),병계산상대관주삼수치rCBF、rCBV、rMTT급rTTP(환측/건측),용자대연건수동측량혈종체적급혈종주위관주결손면적,CT평소도상최대혈종층면수동측량수종면적.결과 26례급성기혈종변연구CBF、CBV교대측경상구감저(tCBF=-8.125、tCBV=-8.671,PCBF、CBV＜0.01);MTT교대측경상구축단(tMTT=-3.246,PMTT＜0.05);TTP교대측경상구연장(tTTP=5.027,PTTP＜0.01).혈종외층구CBV교대측경상구감저(tCBV=-2.337,PCBV ＜0.05);MTT교대측경상구축단(tMTT=-2.421,PMTT＜0.05);TTP교대측경상구연장(tTTP=2.077,PTTP＜0.05);CBF여대측경상구대비차이무통계학의의(tCBF=-1.658,PCBV ＞0.05).급성기혈종변연구rCBF、rCBV저우외층구(trCBF=-8.816,PCBF＜0.01급trCBV=-6.510,PrCBV ＜0.01);혈종변연구rTTP교외층구연장(trTP=4.204,PrTTP ＜0.01).혈종체적여혈종변연구rCBV、rMTT정직선부상관,여rTTP정직선정상관(rCBV=-0.412,PrCBV ＜0.05,rrMTT=-0.437,PrMTT＜0.05,rrTTP=0.475,PrTTP＜ 0.05);혈종체적여혈종주위CBF관주결손면적정직선정상관(r =0.440,P＜0.05).최대혈종층면주위수종면적여혈종체적、혈종주위CBF관주결손면적정직선정상관(r =0.400,r=0.815,P＜0.05).결론 320배저제량용적CT관주성상능구교호적반영급성막상자발성뇌출혈후주위조직적혈류동역학변화;혈종주변존재명현적저관주구,차여혈종적체적상관;혈종점위효응、혈종주위조직결혈시인기급성기뇌수종형성적중요원인.
Objective To discuss the hemodynamic changes in patients with acute supratentorial spontaneous intracerebral hemorrhage (within 72 hours) by using 320-slice of low-dose volume CT perfusion imaging.Methods Twenty-six patients of The First Affiliated Hospital of Wenzhou Medical University during December 2012 to December 2013 with acute supratentorial SICH diagnosed by plain CT scanning and clinic were enrolled.With hematoma maximum level for reference, the hematoma volume, edema area and perfusion defect area were measured, and the perfusion parameters values of the marginal area and outer area of the intracerebral hematoma and contralateral mirror area were measured, including cerebral blood flow (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.Results The CBF, CBV of the marginal area were lower than the contralateral mirror area (tCBF =-8.125, tCBV =-8.671, PCBF,CBV ＜0.01);the MTT of the marginal area was shorter than the contralateral mirror area (tMTT =--3.246, PMTT ＜ 0.05);the TTP of the marginal area was longer than the contralateral mirror area (tTTP =5.027, PTTP ＜ 0.01).The CBV of the outer area was lower than the contralateral mirror area (tCBv =-2.337, PCBV ＜ 0.05);the MTT of the outer area was shorter than the contralateral mirror area (tMTT =-2.421, PMTT ＜ 0.05);the TTP of the outer area was longer than the contralateral mirror area (tTTP =2.077, PTTP ＜ 0.05).There was a siginificant relationship between the volume of acute hematoma and rCBV, rMTT, rTTP of the marginal area (rrCBv =-0.412, PrCBv ＜ 0.05, rrMTT =--0.437, PrMTT ＜ 0.05, rrTTP =0.475, PrMTT ＜ 0.05).Perihematomal CBF perfusion defect area showed a positive linear relation with the volume of acute hematoma (r =0.440, P ＜ 0.05).There was a positive linear relationship between the maximum level edema area and the hematoma volume, perihematomal CBF perfusion defect area (r =0.400, r =0.81, P ＜ 0.05).Conclusions 320-slice of low-dose and volume CT perfusion imaging can perfectly reflect the hemodynamic changes in brain tissuse after acute supratentorial SICH.Hypoperfusion was appeared in perihematomal area of acute supratentorial SICH.The perihematomal brain tissue may exists ischemic injury associated with the size of hematoma.The hematoma placeholder effect, ischemic injury are the important cause of acute brain edema formnation.
