头颅移动CT灌注扫描对重型颅脑损伤患者的临床价值

目的 探讨移动CT灌注扫描（CTP）在重型颅脑损伤（TBI）患者中的临床应用价值。方法 2015年4~9月我院神经外科重症监护室收住重型TBI患者26例，受伤24 h之内同时进行头颅CT平扫（CT1）和移动CTP，并在5 d后复查头颅CT平扫（CT5）。CTP提供脑血流量（CBF）影像、脑血容量（CBV）影像及平均转运时间（MTT）影像；将CTP影像、CT1及CT5进行比较。结果 CTP平均在伤后（15.6±4）h进行。16例（61.5%）患者CTP影像显示灌注改变区域大于CT1显示的病灶区域，其中7例（27%）患者低灌注程度达到缺血水平。3例（11.5%）患者通过CTP扫描发现严重的脑灌注不足，尽管在CT5上并没有明显的缺血梗死表现，根据CTP结果，改变此3例患者的治疗方案，最终只有1例发生严重脑梗死，另外2例恢复良好。与CT1相比，CTP与CT5结果具有更好的一致性。结论 头颅移动CTP可以在创伤后早期对重型TBI患者的脑血流灌注情况作出较为准确的评估，为临床干预提供有力依据。

Clinical value of portable CT perfusion imaging to patients with severe traumatic brain injury

Objective To investigate the clinical value of portable CT perfusion (CTP) imaging to the patients with severe traumatic brain injury (sTBI). Methods The CT plain scan and portable CTP scan were performed in 26 patients with sTBI admitted into neurosurgical intensive care unit 24 hours after the injury. The plain CT scan was performed again 5 days later in all the patients. The images of cerebral blood flow, cerebral blood volume and mean transit time were obtained respectively. The images of CT plain scans 24 hours after the injury, portable CTP, and CT plain scans 5 days later were compared each other. Results CTP imaging was performed (15.6±4) hours after the injury. The area of altered perfusion on portable CT images was larger than the injured areas detected by simultaneous CT plain scan in 16 patients (62%). The degree of hypoperfusion was found to be in the severe range according to quantitative assessment in 7 patients (27%). The clinical management was altered by these CTP findings in 3 patients (12%), in whom severe cerebral hypoperfusion were identified, despite minimal changes on the simultaneous CT plain scan images. Compared with simultaneous CT scan, the CTP scan has better correlativity with the CT scan 5 days later. Conclusion Portable CTP scan can make relatively accurate assessment of the situation of cerebral perfusion in patients with sTBI early after the injury and provide powerful basis for clinical intervention.