CT灌注成像分析颈内动脉重度狭窄或闭塞患者脑血管储备损害

目的 应用5％ CO2作为血管扩张介质,通过CT灌注成像(CTP)分析基础态和激发态颈内动脉重度狭窄或闭塞患者脑血流动力学及脑血管储备(CVR)功能变化特点.方法 对34例患者行基础态CTP和CTA联合检查,对其中10例CTA示颈内动脉或大脑中动脉重度狭窄或闭塞患者行5％CO2混合气体吸入激发态CTP检查.结果 10例单侧颈内动脉重度狭窄或闭塞患者5％CO2激发后,患侧和健侧CVR受损,激发前、后脑血流量(CBF)增幅百分比为-20.25％～26.19％和-13.00％～38.00％,激发前、后脑血容量(CBV)无明显差异(P＞0.05),而达峰时间(TTP)明显延迟(P＜0.05).结论 5％ CO2可作为良好的血管扩张介质用于临床CVR功能研究.颈内动脉重度狭窄或闭塞患者激发后CVR功能受损,反应性减低.

CT perfusion in analysis of impaired cerebrovascular reserves of patients with severe internal carotid artery stenosis or occlusion

Objective To investigate cerebrovascular hemodynamics and cerebrovascular reserves feature of internal carotid artery (ICA) stenosis or occlusion patients in rest and challenge state with CT perfusion (CTP) using 5% CO₂ as challenge medium. Methods Thirty-four patients underwent examination of rest state CTP combining with CTA, and then 10 patients confirmed with internal carotid artery severe stenosis or occlusion underwent challenge CTP after inhaling 5% CO₂ mixed gas. Results Ten patients with unilateral severe stenosed or occluded ICA underwent CTP after inhaling 5% CO₂. CVR was obviously impaired in their abnormal and contralateral hemisphere, and CVR was from -20.25% to 26.19% and from -13.00% to 38.00% before and after challenge. No statistical difference of cerebral blood volume (CBV) parameter was found before and after challenge (P>0.05), but time to peak (TTP) of challenge state obviously delayed than that of rest state (P<0.05). Conclusion Challenge with 5% CO₂ gas is promising for evaluation on cerebral hemodynamics in patients with cerebrovascular disease. CVR was impaired and had low-reactivity in patients with severe stenosis or occlusion of ICA.