多层螺旋CT灌注成像诊断中老年脑胶质瘤

目的:探讨多层螺旋CT灌注成像对中老年脑胶质瘤的诊断作用，以期为临床中老年脑胶质瘤的诊疗提供借鉴。方法:以自2012年6月份以来入我院治疗的确诊为中老年脑胶质瘤的患者为研究对象，先后对患者行多层螺旋CT灌注成像扫描，获得并分析扫描图像中脑组织的多维多层螺旋灌注图像、CT血管成像，计算并分析多层螺旋CT灌注成像图像的病变实质部分和正常脑组织的达峰时间（TTP）、平均通过时间（MTT）、脑血流量（CBF）、脑血容量（CBV）参数、毛细血管表面通透性(ＰＳ)等灌注参数，通过灌注分析软件获得并分析时间-密度曲线(ＴＤＣ)。结果:共纳入患者43例患者，在所有病例中，多维多层螺旋灌注图像平均视觉评价分数明显高于单纯轴向灌注图(P=0.000)，且对病变定位更为精确。CT血管造影（CT angiography，CTA）图中43 例患者中，有36例肿瘤发现供血大动脉，23 例肿瘤有引流静脉，29例大动脉受压，15例大动脉被肿瘤包裹，17例静脉窦受压。统计分析示，多层螺旋CT灌注成像图像的病变实质部分和正常脑组织的脑血流量（CBF）、毛细血管表面通透性(ＰＳ)、脑血容量（CBV）参数等灌注参数，两者之间差异具有统计学意义（P<0.05）。多层螺旋CT灌注成像图像的病变实质部分和正常脑组织的达峰时间（TTP）、平均通过时间（MTT）等灌注参数，两者之间差异无统计学意义（P>0.05）;低、高级别胶质瘤的病灶关键测试参数（critical test parameter,CTP）比较，ＣＢＦ、ＴＴＰ等灌注参数，两者之间差异具有统计学意义（P<0.05）。不同种类颅内肿瘤ＴＤＣ比较，高级别胶质瘤速升速降，低级别胶质瘤速升缓降型。结论:多层螺旋CT灌注成像图像不仅可以实现对邻近大血管颅内肿瘤的全面评价，有利于颅内肿瘤的术前整体评估和精确定位；且对颅内肿瘤的诊断及评价肿瘤与周围大血管的关系、对中老年脑胶质瘤的级别诊断也有一定的临床应用价值。

Clinical study of multislice spiral CT perfusion imaging in diagnosis of brain glioma patient with middle and old age

Objective:To investigate the multi-slice spiral CT perfusion imaging in the diagnosis of glioma，for the clinical diagnosis and treatment of gliomas for reference.Methods:Since June 2012 glioma patients were collected in our hospital in this study，to obtain and analyze the scanned image in the brain tissue of multi-dimensional spiral perfusion images，CT angiography.The lesion of multislice spiral CT perfusion images and normal brain tissue time to peak (TTP)，mean transit time (MTT)，cerebral blood flow (CBF)，cerebral blood volume (CBV) parameters，capillary permeability surface (PS) and other perfusion parameters were obtained.By perfusion analysis software time-density curve (TDC) was obtained.Results:In 43 cases，the multi-dimensional multi-slice spiral perfusion images visually average evaluation score was significantly higher than the axial perfusion maps (P=0.000)，with more accurate positioning of the lesion.In CTA figure of 43 patients，36 cases of cancer had the blood supply artery，23 cases of tumor draining vein，29 cases of large artery pressure，15 cases of tumor aorta wrapped，17 cases of sinus pressure.Statistical analysis showed that in the lesion substantial part of multi-slice spiral CT perfusion imaging of the image and normal brain tissue，cerebral blood flow (CBF)，capillary permeability surface (PS)，cerebral blood volume (CBV) parameters perfusion parameters had statistically significant difference (P<0.05).In lesions substantial part of multi-slice spiral CT perfusion imaging and image of normal brain tissue，time to peak (TTP)，mean transit time (MTT) and other perfusion parameters，had no significant difference (P>0.05).In low and high-grade gliomas lesions comparison，CBF，TTP and other perfusion parameters，had a statistically significant difference (P<0.05).In TDC with different types of brain tumors，high-grade gliomas was steep in rise and drop down,low-grade gliomas was steep in rise and slow down.Conclusion:CT perfusion imaging image can not only achieve a comprehensive evaluation of intracranial tumors near large vessels and overall assessment of intracranial tumors before surgery and precise positioning，also had certain clinical applications in intracranial tumor diagnosis，relationship between evaluation of the tumor and surrounding large vessels and the diagnosis of brain glioma grade.