320排容积CT全脑灌注成像评价烟雾病患者血流重建术前后的脑血流动力学变化

目的 探讨320排容积CT全脑灌注成像在烟雾病治疗前后的价值。方法 回顾性分析18例烟雾病患者术前和术后320排容积CT一站式全脑灌注成像检查的常规CT图像、CTA表现及全脑灌注资料。结果 术前：常规轴位CT显示脑出血7例，脑梗死8例。CTA显示颈内动脉末段轻度狭窄1支，中度狭窄9支，重度狭窄26支；大脑中动脉闭塞19支，大脑前动脉闭塞13支；灌注成像显示脑内异常灌注区22处，与对侧相应区域比较均表现为rCBV、rCBF减低，TTP、MTT及DLY延长（P<0.05）。术后：常规轴位CT无新发出血、梗死，CTA显示血管狭窄、闭塞情况与术前相似，搭桥动脉显示率为100%；灌注成像相对应术前22处异常灌注区域rCBV、rCBF增高，TTP、DLY及MTT较术前缩短，但仅DLY差异有统计学意义（P<0.05）。结论 320排容积CT全脑灌注成像技术不仅可显示烟雾病闭塞的血管及异常血管，还可为术前检查及术后随访提供血流灌注信息。

320-multidetector row CT whole-brain perfusion imaging in evaluation of hemodynamic changes of moyamoya disease patient before and after surgical revascularization

Objective To evaluate the value of 320-multidetector row whole-brain CT perfusion imaging in the patients with moyamoya disease (MD) before and after surgery. Methods 320-multidetector row whole-brain CT perfusion was performed in 18 patients with MD before and after the surgical revascularization, and conventional CT images, CTA performances and whole brain perfusion data were analyzed. Results Before surgery, there were 7 cases with cerebral hemorrhage and 8 cases with cerebral infarction respectively. Different stenosis in cervical internal carotid artery were found (slight in 1 branch, middle in 9 branches, serious in 26 branches). Nineteen branches middle cerebral arteries and 13 branches anterior cerebral arteries were obstructed. Twenty-two abnormal perfusion areas were shown. Compared with the opposite hemicerebrum, relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) decreased, but time to peak (TTP), mean transit time (MTT) and delay time (DLY) increased (all P<0.05). After surgery, all the bypass arteries could be seen. Compared with the preoperative images, the lesions of hemorrhage and infarction did not added and the stenosis and obstruction arteries did not changed; rCBV, rCBF increased and TTP, MTT and DLY decreased, but only DLY had statistical difference (P<0.05). Conclusion 320-multidetector row whole-brain CT perfusion can be used to evaluate of blood flow after the revascularization in patients with MD in the short term.