超声评估大脑中动脉慢性闭塞患者侧支循环的临床意义

目的探讨经颅多普勒超声（TCD）和（或）经颅彩色多普勒超声（TCCS）检查评估单侧大脑中动脉慢性闭塞（CMCAO）患者侧支循环的临床意义。 方法回顾性连续纳入2015年8月至2018年4月苏州大学附属第一医院由TCD和（或）TCCS诊断为单侧CMCAO并经数字减影血管造影（DSA）证实的患者54例，记录患者DSA上软脑膜侧支（LMA）分级。TCD和（或）TCCS检测并记录大脑前动脉（ACA）、大脑后动脉（PCA）的平均流速（MV），并计算其患侧（i）与健侧（c）MV比值（MV_iACA/MV_cACA、MV_iPCA/MV_cPCA）。采用Spearman相关分析法分析ACA及PCA血流动力学参数与LMA分级的相关性。根据临床症状将患者分无症状组（8例），短暂性脑缺血发作（TIA）组（19例）和脑梗死（CI）组（27例），比较3组患者ACA及PCA血流参数差异及相对CT灌注参数的差异。 结果MV_iACA、MV_iACA/MV_cACA与LMA分级均呈显著正相关（r=0.568，P=0.000；r=0.757，P=0.000）；MV_iPCA、MV_iPCA/MV_cPCA与LMA分级均呈正相关（r=0.383，P=0.004；r=0.624，P=0.000）。无症状组、TIA组患者MV_iACA、MV_iPCA、MV_iACA/MV_cACA、MV_iPCA/MV_cPCA均高于脑梗死组，且差异均有统计学意义（P<0.05）。无症状组、TIA组患者相对脑血流量（rCBF）、相对脑血容量（rCBV）均高于脑梗死组患者，且差异均有统计学意义（P<0.05）；相对平均通过时间（rMTT）、相对达峰时间（rTTP）均低于脑梗死组患者，且差异均有统计学意义（P<0.05）。 结论TCD和（或）TCCS上ACA及PCA血流动力学参数与DSA上LMA分级具有明显相关性，且与CT灌注成像结果有良好的一致性，对于指导单侧CMCAO患者选择个体化治疗方案具有重要意义。

The clinical significance of evaluating collateral circulation in patients with chronic middle cerebral artery occlusion by ultrasound

ObjectiveTo study the clinical significance of transcranial Doppler (TCD) and/or transcranial color-coded sonography (TCCS) in the evaluation of collateral circulation in patients with unilateral chronic middle cerebral artery occlusion (CMCAO). MethodsFrom August 2015 to April 2018, 54 consecutive patients diagnosed as unilateral CMCAO by TCD and/or TCCS and confirmed by digital subtraction angiography (DSA) from the First Affiliated Hospital of Soochow University were enrolled retrospectively. The leptomeningeal anastomoses (LMA) grades on DSA were recorded. TCD and/or TCCS were used to measure and record the mean velocity (MV) of bilateral anterior cerebral artery (ACA) and posterior cerebral artery (PCA), and the ratios of ipsilateral MV to the contralateral were calculated (MV_iACA/MV_cACA, MV_iPCA/MV_cPCA). Spearman rank correlation analysis was used to analyze the correlation between ACA, PCA blood flow parameters and LMA grades on DSA. All patients were divided into three groups according to clinical symptoms: asymtom group (n=8) and transient ischemic attack (TIA) group (n=19)and cerebral infarction (CI) group (n=27). The differences in ACA and PCA blood flow parameters and relative CT perfusion parameters were compared between the three groups. ResultsMV_iACA and MV_iACA/MV_cACA were significantly positively correlated (r=0.568, P=0.000; r=0.757, P=0.000); MV_iPCA and MV_iPCA/MV_cPCA were positively correlated with LMA grades on DSA (r=0.383, P=0.004; r=0.624, P=0.000). MV_iACA, MV_iPCA and MV_iACA/MV_cACA, MV_iPCA/MV_cPCA in asymtom group and TIA group were higher than those in CI group, and the differences were statistically significant (P<0.05). Relative cerebral blood flow (rCBF) and relative cerebral blood volume (rCBV) in asymtom group and TIA group were higher than those in CI group, and the differences were statistically significant (P<0.05), the relative mean transit time (rMTT) and relative peak time (rTTP) were lower in asymtom and TIA group than in CI group, and the differences were statistically significant (P<0.05). ConclusionThe hemodynamic parameters of ACA and PCA on TCD and/or TCCS have significant correlation with the LMA grades on DSA and have good consistency with the CTP results, which play an important role in guiding patients with unilateral CMCAO to select individualized treatment strategies.