一站式CT评价烟雾病及烟雾综合征患者出现常春藤征与脑血流动力学及侧支循环的关系

目的 以一站式CT血管造影(CTA)-CT灌注(CTP)观察烟雾病(MMD)/烟雾综合征(MS)常春藤征与脑血流动力学及侧支循环的关系。方法 纳入43例MMD/MS患者，基于MR液体衰减反转恢复序列判断常春藤征，记录存在缺血灶/出血灶脑区(阳性区域);于CTP参数图测量688个脑区的脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)、达峰时间(TTP)及延迟时间(DLY)。以CTA评估侧支循环评分，观察常春藤征(IS)与侧支循环的关系。结果 688个脑区中，166个(166/688,24.13%)可见(IS组)、522个(522/688,75.87%)未见常春藤征(NIS组);较常见IS脑区依次为基底节区、半卵圆中心层面大脑中动脉供血区及半卵圆中心层面大脑前动脉供血区。IS组内阳性区域占比高于NIS组(17.47%vs. 8.05%,P=0.001)。相比NIS组，IS组CBV增加，MTT、TTP及DLY均延长(P均<0.001)而侧支循环分级较低(P=0.006)。结论 MMD/MS患者出现常春藤征提示存在更严重脑灌注损害及侧支循环不良，具有潜在脑缺血/出血风险。

One-stop CT for evaluating relationships of ivy sign and cerebral hemodynamics, collateral circulation in patients with moyamoya disease/moyamoya syndrome

Objective To explore the relationships of ivy sign (IS) and cerebral hemodynamics, collateral circulation in patients with moyamoya disease (MMD)/moyamoya syndrome (MS) using one-stop CT angiography (CTA)-CT perfusion (CTP) imaging. Methods A total of 43 MMD/MS patients were enrolled. IS was assessed based on fluid attenuated inversion recovery sequence MRI, and areas with ischemic or hemorrhagic were recorded as lesion areas. Then perfusion parameters, including cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), time to peak (TTP) and delay time (DLY) in 688 brain regions were measured on CTP parameter maps. Collateral circulation was scored based on 4D CTA, and the relationships between IS and collateral circulation score was analyzed. Results Among 688 brain regions, IS occurred in 166 (166/688, 24.13%) (IS group) but not in 522 (522/688, 75.87%) regions (NIS group). Regions with higher proportion of IS mainly included middle cerebral artery territory at the basal ganglia and central semiovale levels, as well as anterior cerebral artery territory at the central semiovale level. The proportion of lesion regions in IS group was higher than that in NIS group (17.47% vs. 8.05%, P=0.001). Compared with NIS group, CBV increased, MTT, TTP and DLY prolonged in IS group (all P<0.001). The classifications of collateral circulation in IS group were lower than that in NIS group (P=0.006). Conclusion Ivy sign predicted more severe brain damage and poor collateral circulation of MMD/MS patients, which related to potential risk of cerebral ischemia or hemorrhage.