CTPI在对缺血性脑血管疾病患者脑血流动力学评估中的临床价值

doi:10.3969/j.issn.1006-6233.2021.04.022

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摘要 目的: 探究CT灌注成像(CT perfusion imaging,CTPI)在对缺血性脑血管疾病(ischemic cerebrovascular disease,ICVD)患者脑血流动力学评估中的临床价值。方法: 选择140例ICVD患者,患者均行脑CTPI检查,获取异常灌注区健侧与患侧的脑血流动力学参数[脑血容量(cerebral blood volume,CBV)、脑血流量(cerebral blood flow,CBF)、平均通过时间(mean transit time,MTT)、达峰时间(time to peak,TTP)],并计算两侧大大脑半球感兴趣区灌注参数相对值(rCBF、rCBV、rMTT、rTTP 、rCBV- rCBF)。结果: 短暂性脑缺血发作(transient ischemic attack,TIA)患者异常灌注区所在患侧的MTT、TTP水平高于健侧(P<0.05),CBF水平低于健侧(P<0.05),CBV水平与健侧差异无统计学意义(P>0.05);脑梗死(cerebral infarction,CI)患者异常灌注区所在患侧的MTT、TTP水平高于健侧(P<0.05),CBF、CBV水平低于健侧(P<0.05)。CI患者异常灌注区所在健侧或患侧的MTT、TTP水平均对应高于TIA患者,CBF、CBV水平均对应低于TIA患者(P<0.05);CI患者rMTT、rCBF、rCBV、rCBV- rCBF水平均低于TIA患者(P<0.05),rTTP水平与TIA患者比较差异无统计学意义(P>0.05);CI患者NIHSS评分≥5分的比例高于TIA患者(P<0.05)。结论: TIA患者与CI患者CPTI脑血流动力学均存在异常变化,CI患者脑储备能力损害、神经功能损伤较CI患者更严重,CTPI可用于缺血性脑血管疾病中提供有效的血流动力学信息,有助于病情评估。

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关键词 ： CTPI, 缺血性脑血管疾病, 脑血流动力学, 临床价值

Abstract：Objective: To explore the clinical value of CT perfusion imaging (CTPI) in the evaluation of cerebral hemodynamics in patients with ischemic cerebrovascular disease.Methods: A total of 140 patients with ICVD were selected. All patients underwent cerebral CTPI examination, and the cerebral hemodynamic parameters [cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), time to peak (TTP)] were obtained in the healthy side and the affected side of the abnormal perfusion area, and the relative values of perfusion parameters (rCBF, rCBV, rMTT, rTTP, rCBV-rCBF) were calculated in region of interest of the large cerebral hemispheres on both sides. Results: The levels of MTT and TTP in the affected side of the abnormal perfusion area of transient ischemic attack (TIA) patients were higher than those in the healthy side (P<0.05) while the CBF level was lower than that in the healthy side (P<0.05). There was no statistically significant difference in the CBV level compared with that in the healthy side (P>0.05). The levels of MTT and TTP in the affected side of the abnormal perfusion area of cerebral infarction (CI) patients were higher than those in the healthy side (P<0.05) while the levels of CBF and CBV were lower than those in the healthy side (P<0.05). The levels of MTT and TTP in the healthy side or the affected side of the abnormal perfusion area of CI patient were higher than those of TIA patients while the levels of CBF and CBV were lower than those of TIA patients (P<0.05). The levels of rMTT, rCBF, rCBV and rCBV-rCBF of CI patients were lower than those of TIA patients (P<0.05), and there was no significant difference in rTTP level compared with that of TIA patients (P>0.05). The proportion of NIHSS score ≥5 points of CI patients was higher than that of TIA patients (P<0.05). Conclusion: There are abnormal changes in CPTI cerebral hemodynamics in TIA patients and CI patients. The brain reserve capacity and nerve function damage in CI patients are more serious than those in CI patients. CTPI can be used to provide effective hemodynamic information in ischemic cerebrovascular diseases and help to evaluate the disease condition.

Key words： CTPI Ischemic cerebrovascular disease Cerebral hemodynamics Clinical value

基金资助:青海省卫健委指导课题,(编号:2020-wjzdx-86)

引用本文:

朱友义, 高律萍, 曹成瑛, 陈红, 王生元, 罗焕. CTPI在对缺血性脑血管疾病患者脑血流动力学评估中的临床价值[J]. 河北医学, 2021, 27(4): 628-632.
ZHU Youyi, GAO Lvping, CAO Chengying, et al. Clinical Value of CTPI in the Evaluation of Cerebral Hemodynamics in Patients with Ischemic Cerebrovascular Disease. HeBei Med, 2021, 27(4): 628-632.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.04.022 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I4/628