摘要
目的:通过能谱CT血管造影(CTA)成像定量分析颈内动脉斑块成分,并经CT灌注(CTP)测量颈动脉供血区血流灌注情况,探讨斑块成分、管腔狭窄程度与脑血流灌注的关系。方法:选取2017年12月至2019年7月西苑医院收治的68例经超声和CTA筛查确诊的单侧颈内动脉斑块及血管重度狭窄的患者,所有患者均行CTA和CTP检查。使用北美症状性颈动脉内膜剥脱试验(NASCET)法测量颈动脉狭窄程度,利用GE AW4.7后处理工作站对斑块成分进行能谱及脑灌注分析,得到斑块能谱曲线斜率及有效原子序数;同时测量病变侧大脑前及大脑中动脉供血区脑血容量(CBV)、脑血流量(CBF)、对比剂达峰时间(TTP)及对比剂平均通过时间(MTT)。结果:在68例患者中共测量68处符合条件的斑块,其中易损斑块(包块脂质斑块及混合斑块)44处、稳定斑块(纤维斑块)24处。易损斑块和稳定斑块的能谱曲线平均斜率分别为(0.45±0.45)和(1.15±0.39),两者比较差异均有统计学意义(t=2.413,P<0.05);易损斑块和稳定斑块平均有效原子序数为(7.21±1.06)和(8.01±0.63),两者比较差异均有统计学意义(t=2.548,P<0.05)。易损斑块和稳定斑块病变侧大脑前动脉平均TTP为(12.20±1.61)s和(13.59±2.79)s,两者比较差异均有统计学意义(t=-2.607,P<0.05);易损斑块和稳定斑块病变侧大脑前动脉平均MTT为(5.07±1.66)s和(6.09±2.19)s,两者比较差异有统计学意义(t=-2.177,P<0.05)。病变侧血管狭窄程度与大脑中动脉供血区TTP、MTT呈正相关(r=0.537、0.465,P<0.05),与大脑前、中动脉供血区CBF呈负相关(r=-0.281、-0.569,P<0.05)。颈动脉斑块的能谱曲线斜率与病变侧大脑前、中动脉供血区TTP呈正相关(r=0.242、0.246,P<0.05)。结论:CT能谱成像能定量分析颈动脉粥样硬化斑块的成分显示,血管狭窄程度可影响脑组织血流灌注,易损斑块更易引起TTP及MTT延迟,其中TTP更敏感。
Objective:To quantitatively analyze the plaque components of carotid artery through energy spectrum computed tomography angiography(CTA),and to measure the blood flow perfusion in the blood-supply area of carotid artery through CT perfusion(CTP),so as to explore the relationship among plaque component,the degree of luminal stenosis and cerebral blood flow perfusion.Methods:A total of 68 patients with unilateral plaques of carotid artery and severe vascular stenosis who were screened and diagnosed by ultrasound and CTA in Xiyuan Hospital from December 2017 to July 2019 were selected,and all patients underwent CTA examination and CTP examination.North American symptomatic carotid endarterectomy test(NASCET)method was used to measure the degree of carotid stenosis.The GE AW 4.7 post-process workstation was used to conduct analyses of energy spectrum and cerebral perfusion for the plaque component.And then,the slope of energy spectrum curve and the effective atomic number were obtained.At the same time,the cerebral blood volume(CBV),cerebral blood flow(CBF),time to peak(TTP)and mean transit time(MTT)of contrast agent in blood-supplying area of anterior cerebral artery(ACA)and middle cerebral artery(MCA)at the side of lesion were measured.Results:A total of 68 measured plaques of 68 patients met the condition,including 44 vulnerable plaques(including lipid plaques and mixed plaques)and 24 stable plaques(fibrous plaques).The average slopes of the energy spectrum curves of vulnerable plaque and stable plaque were respectively 0.45±0.45 and 1.15±0.39,and the differences were significant(t=2.413,P<0.05).The averagely effective atomic numbers of vulnerable plaques and stable plaques were respectively 7.21±1.06 and 8.01±0.63,and the difference were significant(t=2.548,P<0.05).The average TTP values of the ACA at the side of lesion of vulnerable plaques and stable plaques were respectively(12.20±1.61)S and(13.59±2.79)S,and the difference was significant(t=-2.607,P<0.05).The mean MTT values of the ACA at the side of lesion of vulnerable plaques and stable plaques were respectively(5.07±1.66)S and(6.09±2.19)S,and the difference was significant(t=-2.177,P<0.05).The degree of vascular stenosis at the side of lesion was positively correlated with TTP and MTT in blood-supplying area of middle cerebral artery(MCA)at the side of lesion(r=0.537,0.465,P<0.05),and that was negatively correlated with CBF values in blood-supplying areas of ACA and MCA at the side of lesion(r=-0.281,-0.569,P<0.05),respectively.The slope of the energy spectrum curve of carotid plaque was positively correlated with the TTP values in blood-supplying areas of ACA and MCA at the side of lesion(r=0.242,0.246,P<0.05),respectively.Conclusion:CT spectral imaging can quantitatively analyze the displayed components of carotid atherosclerotic plaque,and the degree of vascular stenosis can affect the blood flow perfusion of cerebral tissue,and the delays of TTP and MTT are more easily caused by vulnerable plaque,and the TTP of them is more sensitivity.
作者
张微
王辰雁
刘鹏
孟玉莲
王羽
张毅
张超越
Zhang Wei;Wang Chenyan;Liu Peng;Meng Yulian;Wang Yu;Zhang Yi;Zhang Chaoyue(Department of Radiology,Xiyuan Hospital of Chinese Academy of Chinese Medical Sciences,Beijing 100091,China;Department of Anesthesiology,Xiyuan Hospital of Chinese Academy of Chinese Medical Sciences,Beijing 100091,China)
出处
《中国医学装备》
2024年第2期59-63,共5页
China Medical Equipment
关键词
颈动脉斑块
斑块成分
能谱成像
灌注参数
Carotid artery plaque
Plaque composition
Spectral imaging
Perfusion parameter
作者简介
通信作者:张超越,Email:530576873@qq.com。
