CT灌注成像对烟雾病术后桥血管再通及手术前后脑血流变化的评价

目的 探讨CT灌注成像技术（CTP）在烟雾病颞浅-大脑中动脉塔桥术（STA-MCA）术后桥血管再通及手术前后脑血流变化的价值.方法 22例烟雾病患者在实施STA-MCA手术前、术后行CTP及CTA检查,对患者手术前后脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）和达峰时间（TTP）进行定量、定性分析,计算术侧/对侧相对比值（rCBF、rCBV、rTTP及rMTT值）.采用配对t检验或配对序符号检验比较手术前后CT灌注参数值及相对值的差异.结果 22例患者术后CTA检查显示桥血管均通畅.22例患者术前手术侧与对比侧CTP参数值比较,患侧大脑中动脉分布区的CBF降低,CBV增加,MTT延长;烟雾病患者血管搭桥术后手术侧与手术前比较发现,大脑中动脉分布区的rCBF增加,rCBV不变,rMTT降低.差异有统计学意义（P＜0.05）.结论 CTP联合CTA技术,可显示烟雾病患者脑部血管形态和血容量改变.对烟雾病STA-MCA搭桥术后桥血管再通情况及脑血流动力学变化同时进行评价,具有极高的临床应用价值.

Evaluation of extra-intracranial bypass and CBF of pre-and post-operationg with CTP on moyamoya diseases

Objective The value of CTP was discussed in the evaluation of STA-MCA bypass and CBF of preoperation and after operation with CTP on moyamoya diseases.Methods 22 cases of STA-MCA bypass were collected.All the patients were performed CTP and CTA before and after operation.The figures of rCBF,rCBV,rTTP and rMTT were analysed by comparison.Results After operation,CTA showed that 22 cases of anastomosis were unimpeded.Before operation,CTP showed that all the cases decreased CBF,developed rCBV and delayed rMTT.In comparison to preoperation,22 cases developed rCBF,decreased rMTT,and rCBV did not ckange.There was significantly difference between pre-and post-operation （P ＜0.05）.Conclusion The changes in the cerebral hemodynamics and the pattern of vessles may be detected by CTP and CTA.CTP and CTA could provide measurement of CBF and anastomosis and play an important role in evaluating effect of extra-intracranial bypass surgery on moyamoya diseases.