能谱计算机断层扫描容积螺旋穿梭扫描技术在烟雾病中的初步应用研究

摘要/Abstract

摘要：

目的探讨能谱计算机断层扫描（computed tomography，CT）容积螺旋穿梭扫描技术在烟雾病患者血管和灌注成像中的应用价值。方法对4例术前、11例术后的烟雾病患者行容积螺旋穿梭扫描检查，获得四维CT血管成像及全脑CT灌注成像。采用CT平扫分型、颈内动脉分期、侧支循环分类、烟雾状血管丰富程度分期、CT灌注异常分期及Alberta卒中早期CT评分的评估标准，分左右大脑半球综合评价烟雾病的脑实质和脑血管病变。结果术前4例烟雾病患者，8个半球中的5个半球（62.5%）处于颈内动脉分期的III期；本组侧支循环主要来源于颅底血管网（46.1%）；梗死分期中，8个半球（100%）出现异常，其中7个半球（87.5%）处于梗死前期的Ⅱ期，且Alberta卒中早期CT评分均在10分以上。术后11例（22个半球）患者均行颞浅动脉-大脑中动脉搭桥术，其中左侧6例，右侧4例，双侧1例，吻合血管通畅率为100%；梗死分期中19个半球（86.4%）出现异常，其中10个半球（45.5%）处于II期、8个半球（36.4%）处于Ⅲ期。结论能谱CT容积螺旋穿梭技术可以同时获得四维CT血管成像及全脑CT灌注成像，能对判断烟雾病患者的动脉分期、侧支循环、脑灌注情况、术后血管吻合等影像学信息发挥重要作用。

文章导读： 【点睛】
本研究将能谱计算机断层扫描的新技术应用在烟雾病患者手术前后血管及灌注情况的评估中，具有创新性。

关键词: 烟雾病; 能谱计算机断层扫描

Abstract:

Objective To investigate the value of spectral computed tomography(CT) volume shuttle scanning technique in assessment of vascular status and perfusion in patients with moyamoya disease. Methods Spiral CT volume shuttle scanning was performed in 4 preoperative cases and 11 postoperative cases with moyamoya disease, to obtain four dimensional computed tomography angiography(CTA) and whole brain CT perfusion images. The evaluation standards of noncontrast CT classification, internal carotid artery stage, collateral circulation classification, rich puff-like network stage, abnormal CT perfusion stage and Alberta Stroke Program Early CT Score were applied to analyze cerebral parenchyma and vascular lesions of moyamoya disease in left and right cerebral hemispheres. Results In 4 preoperative patients(8 hemispheres) with moyamoya disease, 5(62.5%) of 8 hemispheres were in stage Ⅲ of internal carotid artery stage. In this group, the collateral circulation(46.1%) mainly originated from skull base vascular network. In addition, 8 hemispheres(100%) appeared abnormal on computed tomography perfusion(CTP), 7 of which(87.5%) were in pre-infarction stage II, and had Alberta Stroke Program Early CT Score more than 10 points at the same time. In 11 cases(22 hemispheres) who underwent superficial temporal artery to middle cerebral artery bypass, 6 were performed on the left, 4 were completed on the right and 1 were double,whereas the bypass patency rate was 100%. Moreover, the infarction stage of 19 hemispheres(86.4%) were abnormal, in which 40.1%(9/22) were Ⅱ stage and 36.4%(8/22) were Ⅲ stage, respectively. Conclusion Four dimensional CT angiography and whole brain CT perfusion are obtained by spectral CT volume shuttle scanning technology. The images have great values for the assessment of internal carotid artery stage, collateral circulation, graft patency and cerebral hemodynamics changes postoperatively.

Key words: Moyamoya disease; Spectral computed tomography

张亚男1，3，高培毅1，2，3，张东4，顾卫彬1，3，马淑杰1，3，薛静1，2，3. 能谱计算机断层扫描容积螺旋穿梭扫描技术在烟雾病中的初步应用研究[J]. 中国卒中杂志, 2013, 8(02): 92-99.

ZHANG Ya-Nan*, GAO Pei-Yi, ZHANG Dong, GU Wei-Bin, MA Shu-Jie, XUE Jing.. Preliminary Application Study of Spectral Computed Tomography Volume Shuttle Scanning Technique in Moyamoya Disease[J]. Chinese Journal of Stroke, 2013, 8(02): 92-99.

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