蛛网膜下腔出血后脑痉挛的临床研究及CT征象分析

目的分析蛛网膜下腔出血(SAH)后脑痉挛(CVS)的临床特点及CT表现。方法收集2010年2月-2015年5月来我院就诊的54例SAH患者的临床资料,入院后所有患者均接受CT、数字减影血管造影(DSA)检查,且临床资料完整,以DSA作为金标准,统计CT对SAH后CVS诊断准确性,总结其CT影像学表现。结果 CTA漏诊1例ACA、MCA远侧段CVS,其诊断CVS准确率为88.24%,略低于DSA,但对比差异无统计学意义(P0.05);SAH并CVS者CBV、CBF低于SAH无CVS者(P0.05),其MTT、TTP明显长于SAH无CVS者,对比差异有统计学意义(P0.05)。结论 SAH后CVS患者脑灌注降低,MTT、TTP延长,痉挛血管可见均匀性狭窄,采用CT、CTP诊断与DSA符合率高,可为临床诊治提供影像学依据。

Clinical Study of Cerebral Vascular Spasm after Subarachnoid Hemorrhage and Analysis of CT Findings

Objective To analyze the clinical characteristics and CT findings of cerebral vascular spasm (CVS) after subarachnoid hemorrhage (SAH).Methods The clinical data of 54 patients with SAH who were treated in our hospital between February 2010 and May 2015 were collected. All patients were examined by CT and digital subtraction angiography (DSA) after admission, and the clinical data were complete. With DSA as the golden standard, the accuracy of CT in the diagnosis of CVS after SAH was statistically analyzed. The CT imaging findings were summarized.Results There was 1 cases with ACA, MCA distal segment CVS missed diagnosed by CTA, and the accuracy rate in the diagnosis of CVS was 88.24%, slightly lower than that of DSA (P>0.05); CBV and CBF in patients with SAH and CVS were lower than those in patients with SAH and without CVS (P<0.05). The MTT and TTP were significantly longer than those of patients with SAH and without CVS (P<0.05).Conclusion The cerebral perfusion of patients with CVS after SAH decreases. MTT and TTP are prolonged. Vascular spasm shows homogeneous stenosis. The coincidence rate of CT and CTP diagnosis with DSA is high, which can provide imaging basis for clinical diagnosis and treatment.