CT灌注成像对颈动脉狭窄及闭塞患者脑灌注的评价

目的 评价单侧颈动脉狭窄及闭塞患者的脑灌注改变,探讨CT灌注成像(CTP)对脑缺血事件高危人群的筛查价值.方法 25例单侧颈动脉狭窄及闭塞患者行64层CTP检查,参照北美症状性颈动脉内膜切除术(NASCET)标准将狭窄分为中、重度和闭塞三组,计算额、颞、枕叶、基底节及前后分水岭区的rCBF、rCBV、rTS、rTP,对三组间相对灌注值进行组间比较.结果 (1)伪彩色图:三组间所有部位两侧的CBF和CBV均无差异;闭塞组所有患者及4例重度狭窄组患者的TS图、TP图显示两侧存在差异.(2)颞叶、基底节区及前后分水岭区灰白质的rCBF、rCBV差异无统计学意义(P>0.05).(3)颞叶、基底节区的rTS、rTP三组间差异有统计学意义(P<0.05).(4)前分水岭区灰质及白质、后分水岭区灰质的rTS、TP三组间差异有统计学意义(P<0.05);后分水岭区白质的rTS三组间差异有统计学意义(P<0.05),但三组间,rTP差异无统计学意义(P>0.05).结论 CT灌注成像能有效评价颈内动脉狭窄或闭塞患者脑灌注的改变并帮助临床筛查高危患者.

CT perfusion study of cerebral hemodynamics in patients with unilateral stenosis or occlusion of the ICA

Objective First, to investigate hemedynamic changes in patients with unilateral stenosis or occlusion of ICA using CTP and, second to evaluate its potential value in identifying higher risk patients for TIA or stroke. Methods Twenty - five patients (21 men, 4 women; mean age, 56.72±11.07 years) with unilateral stenosis or occlusion of the ICA underwent 64 - detector CTP. The patients were divided into three stenotic groups according to the NASCET criteria. The rCBV, rCBF, rTS and rTP were derived by the comparison between stenotic and contrlateral hemispheres and the data were analyzed by using the One - way ANOVA and Kruskal - Wallis test. Results (1) All the patients in occlusion group and 4 patients in high - grade group had abnormal perfusion characterized on TS and TP color maps. (2) No statistically significant difference in rCBV and rCBF was found among the three stenotic groups. (3)There were statistical significance in rTS and rTP of temporal lobe and basal ganglia region ( P <0. 05 ). (4)The gray matter and white matter of the anterior washeld regions and the gray matter of posterior washeld region had statistical significance among three stenotic groups ( P < 0. 05 ). However, only the rTS in the white matter of posterior wasbeld region had statistical significance among three stenotic groups (P<0. 05). Conclusion CTP may provide valuable information of the cerebral hemodynamic status in patients with unilateral stenosis or occlusion of the ICA and identifying patients at higher risk for TIA or stroke.