多层CT评价颈动脉重度狭窄性病变的初步研究

目的探讨多层CT脑灌注技术和头颈部CT灌注成像(CTA)技术联合应用评价颈动脉重度狭窄性病变的临床价值。方法对23例有症状的颈动脉重度狭窄性病变进行颅脑平扫、脑CT灌注和头颈部CTA联合检查。利用CTA对血管的狭窄程度、狭窄部位进行评价,利用CT灌注对脑血流动力学状态进行评价。选10名年龄相匹配的志愿者行CT灌注检查,作为CT灌注的对照组。结果CTA显示一侧颈内动脉闭塞12例,一侧颈内动脉重度狭窄11例。7例为单侧颈内动脉病变,16例为多血管多部位狭窄,包括对侧颈动脉狭窄,单侧或双侧椎动脉狭窄或闭塞,颅内血管狭窄或闭塞。脑CT灌注显示病变同侧灌注异常17例,闭塞组(8例)和重度狭窄组(9例)在灌注异常的发生率上差异无统计学意义。单发组(3例)和多发组(14例)在灌注异常发生率上差异有统计学意义(P<0·05)。结论颈动脉重度狭窄性病变多伴有同侧脑灌注的异常(17/23),多血管病变脑内灌注异常的发生率多于单发的颈动脉狭窄或闭塞。CTA和CT灌注技术联合应用可更加全面地评价颈动脉狭窄性病变,具有较高的临床应用价值。

Primary study on evaluation of severe carotid stenosis and occlusion disease by using multi-slice CT

Objective To evaluate the combination use of multi-slice CT angiography (CTA) and CT perfusion in patients with severe carotid stenosis disease. Methods All 23 symptomatic patients with severe carotid stenosis underwent CT plain scanning, CT perfusion and CTA examination. The degrees and locations of artery stenosis were assessed with CTA, and cerebral hemodynamic changes with CT perfusion. Ten normal persons underwent CT perfusion as did in control group. Results Eleven cases of severe carotid stenosis(>70%) and 12 of carotid occlusion were found with CTA, and 16 cases were multiple arteries disease, including contralateral carotid stenosis, vertebral arteries stenosis and cerebral arteries stenosis or occlusion. CT perfusion demonstrated that there appeared cerebral hemodynamic impairment in 17 patients, showing no statistic differences between groups of occlusion (8 cases ) and stenosis (9 cases ),but the occurrence of hemodynamic impairment was higher in group of multiple arteries disease(14 cases) than in single arteries disease group (3 cases). Conclusions Cerebral hemodynamic impairment is common in severe carotid stenosis disease, with a higher incidence in patients with multiple arteries carotid disease than in those with single carotid disease. Severe carotid stenosis disease should be evaluated comprehensively by using combination of CTA and CT perfusion.