颅骨修补前后脑血流变化的CT灌注评价

目的探讨颅骨修补手术前后患者脑血流的变化。方法对24例早期行颅骨修补手术患者,在颅骨修补前1～2d和术后10～14d,应用16排螺旋CT做脑灌注扫描,记录大脑皮层、基底节和丘脑区域灌注图像上rCBV、rCBF、MTT及TTP等参数值。分析颅骨修补前后双侧大脑皮质,基底节和丘脑相关区域血流灌注数据的变化。结果颅骨修补术前患侧皮质区CBF明显低于对侧,和健侧相比差异具有统计学意义(P<0.01);术后患侧在皮质区CBF显著上升,和术前相比,差异具有统计学意义(P<0.01)。两侧基底节和丘脑区在术前术后脑血流相关数值虽有所上升,但前后相比差异无统计学意义(P>0.05)。结论头颅CT灌注可以及时检测颅脑外伤后不同阶段脑组织血流量的变化,而颅骨修补术可以明显提高患侧大脑皮质区的脑血流量,进而可能促进神经功能恢复。

CT perfusion evaluation of cerebral blood flow before and after cranioplasty

Objective To study the change of cerebral blood flow （CBF） after cranioplasty. Methods By using perfusion CT, the changes of regional cerebral blood volume, rCBV, regional cerebral blood flow, rCBF, mean transit time, MTT, transit time peak, TIP in 24 patients undergoing early cranioplasty were detected 1-2 days before and 14 days after surgery. The quantity of cerebral blood flow was analyzed at the injured side, contralateral cortex, basal nuclei and thalamus. Results The CBF of cortex before cranioplasty at injured side increased with contralateral cortex with statistical significance （P 〈 0.01 ）. The CBF of cortex after cranioplasty at injured side increased with statistical significance（P 〈0.01 ）. The CBF of cortex, basal nuclei, thalamus on contralateral had no statistical significance. The CBF of corresponding to the regions in the control group was more than that cranioplasty group, but had no statistical significance （P 〉 0.05 ）. Conclusion The CT perfusion scans could in time measure the change of cerebral blood flow after skull trauma;Cranioplasty might promote CBF of injured cortex and improve neurological status.