大脑中动脉狭窄或闭塞患者侧支循环320排计算机断层扫描血管成像联合脑灌注成像研究

摘要/Abstract

摘要：

目的利用320排计算机断层扫描血管成像（computed tomography angiography，CTA）及脑灌注成像（computed tomography perfusion imaging，CTP）探讨单侧大脑中动脉（middle cerebral artery，MCA）重度狭窄或闭塞的急性缺血性卒中患者侧支循环与脑灌注的关系。方法对72例单侧MCA重度狭窄或闭塞的急性缺血性卒中患者行头部320排CTA及CTP检查，根据有无侧支循环分为2组，对2组CTA和CTP情况进行分析比较。结果共入组72例患者，有侧支循环组58例，无侧支循环组14例。有侧支循环组38例（65.52%）MCA闭塞，无侧支循环组中5例（35.71%）MCA闭塞，两组差异有显著性（P=0.041）。有侧支循环组脑灌注代偿率高于无侧支循环组（68.97% vs 21.43%，χ2＝10.595，P＝0.001）；在CTP异常的68例患者中，有侧支循环者54例，无侧支循环者14例，有侧支循环组患侧的脑血容量［35.00（29.92，41.13）ml/100?g vs 26.25（18.23，37.18）ml/100?g］及脑血流量［（2.39±0.73）ml/100?g·min vs （1.75±0.72）ml/100?g·min］高于无侧支循环组，P分别为0.007和0.040。但2组患侧平均通过时间（mean transit time，MTT）及平均达峰时间（time to peak，TTP）差异无显著性。结论 320排CTA联合CTP检查显示急性缺血性卒中患者中有侧支循环者脑灌注代偿率高，而且其脑血容量和脑血流量均高于无侧支循环者。

文章导读： 本研究采用320排计算机断层扫描血管成像联合灌注成像探讨单侧大脑中动脉狭窄或闭塞患者侧支循环和脑灌注情况，为缺血性脑血管病的诊断和诊治提供一种新方法。

关键词: 大脑中动脉; 侧支循环; 脑灌注; 320排计算机断层扫描

Abstract:

Objective To study the relationship between collateral circulation and cerebral perfusion in acute ischemic stroke patients with unilateral middle cerebral artery (MCA) of severe stenosis or occlusion by 320-slice computed tomography angiography (CTA) and computed tomography perfusion imaging (CTP). Methods 320-slice head CTA and CTP were performed in 72 acute ischemic stroke patients with unilateral MCA of severe stenosis or occlusion. All patients were divided into two groups according the status of collateral circulation. Comparisons were made between the results of the two groups in CTA and CTP. Results All of the 72 patients had been enrolled into the study. There were 58 cases in the group of patients with collateral circulation and 14 cases in the group of patients without collateral circulation. The group of patients with collateral circulation had 38 cases (65.52%) of the MCA occlusion, while there were only 5 cases (35.71%) in the other group, the differences between the two groups were significant (P=0.041). Patients with collateral circulation had a significantly higher rate of cerebral perfusion compensaion than those without collateral circulation (68.97% vs 21.43%, χ2=10.595, P=0.001). There were 68 patients with CTP abnormality, and 54 cases of them had collateral circulation while the other 14 cases didn't have. The cerebral blood volume (35.00[29.92, 41.13]ml/100?g vs 26.25[18.23, 37.18]ml/100?g) and cerebral blood flow ([2.39±0.73]ml/100?g·min vs [1.75±0.72]ml/100?g·min) in the affected side in patients with collateral circulation were higher than those of the group without collateral circulation. But there was no significant difference between these two groups on comparing mean transit time (MTT) and time to peak (TTP). Conclusion 320-slice CTA with CTP examination showed that the patients with collateral circulation had a higher rate of cerebral perfusion, and the cerebral blood volume and cerebral blood flow were also higher than those without collateral circulation.

Key words: Middle cerebral artery; Collateral circulation; Cerebral perfusion; 320-slice computed tomography

林盛东，黎红华，陈信坚，崔敏，邹佳妮，易娟. 大脑中动脉狭窄或闭塞患者侧支循环320排计算机断层扫描血管成像联合脑灌注成像研究[J]. 中国卒中杂志, 2015, 10(01): 56-60.

LIN Sheng-Dong, LI Hong-Hua, CHEN Xin-Jian, CUI Min, ZOU Jia-Ni, YI Juan.. Study on Collateral Circulation in Patients with Unilateral Middle Cerebral Artery Stenosis or Occlusion by 320-slice Computed Tomography Angiography and Computed Tomography Perfusion Imaging[J]. Chinese Journal of Stroke, 2015, 10(01): 56-60.

参考文献

参考文献

1 Wong KS, Huang YN, Gao S, et al. Intracranial stenosis in Chinese patients with acute stroke[J]. Neurology, 1998, 50:812-813.

2 Liebeskind DS.Collateral circulation[J]. Stroke, 2003, 34:2279-2284.

3 中华医学会全国第四届脑学病学术会议. 各项脑血管病诊断要点[J]. 中华神经科杂志, 1996, 29:379.

4 迟相林, 于永鹏, 王道珍. 高血压是一种存在方式相关性疾病[J]. 中华高血压杂志, 2014, 22:3-6.

5 陆菊明. 中国2型糖尿病防治指南(2013年版)更新要点的解读[J]. 中国糖尿病杂志, 2014, 22:865-869.

6 俞羚, 董荃, 宋叶平, 等. 面向21世纪的卒中新定义:美国心脏病学会和美国卒中学会声明[J]. 神经病学与神经康复学杂志, 2013, 10:105-120.

7 Carpenter JP, Lexa FJ, Davis JT. Determination of duplex Doppler ultrasound criteria appropriate to the North American Symptomatic Carotid Endarterectomy Trial[J]. Stroke, 1996, 27:695-699.

8 高培毅, 林燕. 脑梗死前期脑局部低灌注成像的CT灌注成像的表现及分期[J]. 中华放射学杂志, 2003, 37:882-886.

9 卢洁, 李坤成. 颈内和大脑中动脉狭窄与闭塞的MR灌注成像研究[J]. 中国医学影像技术, 2004, 20:1797-1799.

10 Kulik T, Kusano Y, Aronhime S, et al. Regulation of cerebral vasculature in normal and ischemic brain[J]. Neuropharmacology, 2008, 55:281-288.

11 Heiserman JE, Dean BL, Hodak JA, et al. Neurologic complications of cerebral angiography[J]. AJNR Am J Neuroradiol, 1994, 15:1741-1745.

12 Kaufmann TJ, Huston J, Mandrekar JN, et al. Complications of diagnostic cerebral angiography:evaluation of 19,826 consecutive patients[J]. Radiology, 2007, 243:812-819.

13 Lev MH, Romero JM, Goodman DN, et al. Total occlusion versus hairline residual lumen of the internal carotid arteries:accuracy of single section helical CT angiography[J]. AJNR Am J Neuroradiol, 2003, 24:1123-1129.

14 Leelerc X, Ganvrit JY, Pruvo JP. Usefulness of CT angiography with volume rendering after carotid angioplasty and stenting[J]. AJR Am J Roentgenol, 2000, 174:820-822.

15 刘忠, 王丽, 陈信坚, 等. 320排动态容积CT诊断脑血管病的价值[J]. 中国临床神经外科杂志, 2013, 18:391-393.

18 何洁, 吉训明, 张人玲, 等. 单侧大脑中动脉狭窄或闭塞侧支循环与脑缺血的关系[J]. 首都医科大学学报, 2008, 29:38-41.

16 Kitagawa K, Yagita Y, Sasaki T, et al. Chronic mild reduction of cerebral perfusion pressure induces ischemic tolerance in focal cerebral ischemia[J]. Stroke, 2005, 36:2270-2274.

17 高艳, 李坤成, 杜祥颖, 等. 64排螺旋CT脑灌注和CT血管成像在大脑中动脉狭窄或闭塞的应用[J]. 中国医学影像技术, 2006, 22:1155-1158.

19 Kajimoto K, Moriwaki H, Yamada N, et al. Cerebral hemodynamic evaluation using perfusion-weighted magnetic resonance imaging:comparison with positron emission tomography values in chronic occlusive carotid disease[J]. Stroke, 2003, 34:1662-1666.

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