摘要
目的:探讨全脑CT灌注成像(CTP)联合头颈部CT血管成像(CTA)在颞浅动脉-大脑中动脉(STA-MCA)搭桥术治疗慢性缺血性脑血管病(ICVD)中的临床应用价值。方法:选取2020年5月至2024年10月成都市第二人民医院和德阳市人民医院收治的50例(成都市第二人民医院29例,德阳市人民医院21例)疑似慢性ICVD患者,所有患者术前均行全脑CTP及头颈部CTA检查,分析两种成像联合对有STA-MCA手术指征术前评估效能;对比术前患侧与健侧,术后患侧与健侧及手术前后患侧CTP脑灌注参数[脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)、排空时间(TTD)、达峰时间(T_(max))]变化;通过CTA图像分析搭桥血管的走行及吻合口情况;统计术后脑高灌注综合征(CHS)患者CTP参数,并分析术后患侧脑灌注值变化与CHS的关系以及随访情况。结果:50例疑似慢性ICVD患者经CTA联合CTP筛选出34例具有STA-MCA搭桥手术指征的慢性ICVD患者(血管重度狭窄或闭塞同时伴有CTP灌注减低),其余16例不符合搭桥手术指征患者被排除。34例慢性ICVD患者术前患侧CBF值低于健侧,MTT、TTD及T_(max)值均高于健侧,差异有统计学意义(t=76.648、6.030、10.638、14.063,P<0.05);患侧CBV值与健侧比较,差异无统计学意义(P>0.05)。术后患侧CBF值较术前升高,MTT、TTD及T_(max)值较术前均降低,差异有统计学意义(t=8.578、7.166、11.321、11.912,P<0.05);CBV值与术前比较,差异无统计学意义(P>0.05)。34例慢性ICVD患者中排除术后6例出现CHS,28例慢性ICVD患者患侧与健侧CTP灌注参数比较,差异均无统计学意义(P>0.05)。CTA显示,所有患者颞浅动脉管径大小及走行情况均显示清晰,搭桥血管均畅通,吻合口显影良好。34例慢性ICVD患者均顺利完成单侧STA-MCA搭桥术,术后根据患者临床症状及CTP复查结果判定,6例(占17.7%)患者为CHS,表现为患侧CBF值为(60.81±5.79)ml/100(g·min),明显高于健侧(53.30±5.21)ml/100(g·min);MTT值为(2.9±0.8 2)s,明显低于健侧(4.2±1.1)s,其差异均有统计学意义(t=2.358、2.341,P<0.05)。术后对34例慢性ICVD患者随访2~17个月,无死亡病例,多数患者临床症状明显改善,未出现严重不良事件。结论:全脑CTP联合头颈部CTA检查有利于术前准确判定血管狭窄程度和脑灌注情况,以及筛选有STA-MCA手术指征的慢性ICVD患者;还可评估术后搭桥血管畅通情况、脑灌注恢复程度及CHS发生的可能性,具有重要临床指导意义。
Objective:To investigate the clinical application value of whole brain computed tomography perfusion(CTP)imaging combined with computed tomography angiography(CTA)on head and neck in treating chronic ischemic cerebrovascular disease(ICVD)by superficial temporal artery-middle cerebral artery(STA-MCA)bypass.Methods:Fifty patients with suspected chronic ICVD who admitted to Chengdu Second People's Hospital and Deyang People's Hospital(29 cases from Chengdu Second People's Hospital and 21 cases from Deyang People's Hospital)from May 2020 to October 2024 were selected.All patients underwent whole-brain CTP examination and CTA examination on head and neck before the surgery,and then,the preoperative assessment efficacy of the combination of the two examination for patients with STA-MCA surgical indication was analyzed.The changes of the CTP parameters[cerebral blood volume(CBV),cerebral blood flow(CBF),mean transit time(MTT),time to drain(TTD),and time to maximum(Tmax)]between the affected side and the healthy side before surgery,and between them after surgery,and these parameter of affected side between before and after surgery were compared respectively.The course and the anastomosis conditions of the bypass vessels were analyzed through CTA images.The CTP parameters of patients with postoperative cerebral hyperperfusion syndrome(CHS)were statistically analyzed.Then,the relationship between the changes of cerebral perfusion values on the affected side after surgery and CHS,as well as the follow-up situation,were analyzed.Results:In 50 patients with suspected chronic ICVD,34 patients with surgical indication of STA-MCA bypass were screened out by CTA combined with CTP,who existed severely narrowed or occluded blood vessels accompanied by reduced CTP,and other 16 cases who did not meet surgical indication of STA-MCA bypass were excluded.In 34 patients with chronic ICVD,the preoperative CBF value of affected side was lower than that of healthy side,and the preoperative MTT,TTD and Tmax values of affected side were all higher than those of the healthy side,and the differences were statistically significant(t=6.648,6.030,10.638,14.063,P<0.05),while there was not significant difference in CBV value between two sides(P>0.05).In the affected side,the postoperative CBF value was higher than preoperative CBF value,and the postoperative MTT,TTD and Tmax values were lower than preoperative these indicators,and the differences were statistically significant(t=8.578,7.166,11.321,11.912,P<0.05).There was no significant difference in the CBV value between before and after surgery(P>0.05).In 34 patients with chronic ICVD,there was not significant difference in CTP parameters between the affected side and the healthy side in 28 patients with chronic ICVD after 6 patients with CHS were excluded(P>0.05).The results of CTA showed that the diameter size and course of superficial temporal artery of all patients were clearly displayed,and the bypass vessels of them were unblocked,and the anastomoses of them were well developed.All 34 patients with chronic ICVD successfully completed unilateral STA-MCA bypass surgery.After the surgery,based on the clinical symptoms and the CTP reexamination results of the patients,it was determined that 6 patients(17.7%)were CHS,whose appearances were the CBF value of affected side was(60.81±5.79)ml/100(g·min),which was significantly higher than that[(53.30±5.21)ml/100(g·min)]of the healthy side.The MTT value of affected side was(2.9±0.82)s,which was significantly lower than that of the healthy side(4.2±1.1)s,and the differences were statistically significant(t=2.358,2.341,P<0.05).In the postoperative follow-up of 2 to 17 months for patients,there was not dead case,and the clinical symptoms of the most of patients were improved significantly,and there was no serious adverse events.Conclusion:Whole-brain CTP combined with CTA examination on head and neck is conducive to accurately determine the degree of vascular stenosis and cerebral perfusion before surgery,and screen patients with chronic ICVD who occurred indications of STA-MCA surgery,and can also assess the patency of bypass vessels,the recovery degree of cerebral perfusion,and the possibility of occurring CHS after surgery,which has important clinical guiding value.
作者
张园园
马春
任思勰
李盼盼
张新宇
Zhang Yuanyuan;Ma Chun;Ren Sixie;Li Panpan;Zhang Xinyu(Department of Imaging,Chengdu Second People's Hospital,Chengdu 610017,China;Department of Radiology,Deyang People's Hospital,Deyang 618000,China;Department of Neurosurgery,Chengdu Second People's Hospital,Chengdu 610017,China)
出处
《中国医学装备》
2025年第9期46-51,共6页
China Medical Equipment
基金
四川省自然科学基金(24NSFSC8826)
四川省科技计划项目(2025SF0731)。
作者简介
通信作者:张新宇,Email:353922710@qq.com。
