CT灌注成像对烟雾病行脑血管重建术的疗效评价

目的 探讨CT灌注成像技术(CTP)在出血型烟雾病中的应用价值和评价颞浅-大脑中动脉搭桥术(STA-MCA)手术疗效.方法 20例出血型烟雾病患者在实施STA-MCA手术前、术后1周和术后3个月分别行CTP检查.对患者手术前腩血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)进行定量和定性分析,并对手术前后及随访的CBF、CBV、MTT进行对比分析.结果 10例患者术前手术侧与对侧比较,额、颞叶CBF降低,CBV增加,MTT延长;术后1周复查,术侧额、颞叶与术前比较发现,rMTT降低,rCBV不变,rCBF增加;术后3个月复查,与术后1周比较,额、颞叶rMTT、rCBV降低;差异有统计学意义(P<0.05).结论 CTP能检测脑缺血的部位,有助于出血型烟雾病术前治疗方法的选择和术后疗效观察;出血型烟雾病仍存在脑灌注严重不足,以额、颞叶明显,STA-MCA搭桥术能增加额、颞叶脑血供,预防缺血或出血性卒中发生.

Using CT perfusion imaging to evaluate the effect of STA - MCA bypass on hemorrhagic moyamoya disease

Objective To discuss the application of CT perfusion imaging in hemorrhagic varieties moyamoya disease and evaluation effect of STA - MCA bypass. Methods There were 20 patients with hemorrhagic varieties moyamoya disease. Before and after surgery, CTP studies were performed, and three cases have carried on the reexamination in 3 months after surgery. CTP data were analyzed both visually and by quantitative regional analysis. Results Before surgery, CBF decreased, CBV increased and MTT extension of frontal and temporal lobe in surgery side was observed. After surgery, rCBF increased and rMTT decreased in frontal and temporal lobe after 1 week; both rCBF and rMTT decreased in frontal and temporal lobe after 3 months. There was significant difference( P < 0. 05). Conclusion CT perfusion imaging can detect the location of cerebral ischemia, provide useful information in choice of treatment and observation of curative effects. The frontal and temporal lobes showed severe hemedynamic ischemia in hemorrhagic varieties moyamoya disease.