CT灌注成像在联合血管重建术治疗烟雾病中的应用

发布时间：2018-06-07 18:25

  本文选题：烟雾病 + CT灌注成像　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:探讨CT灌注成像(CTP)在烟雾病联合血管重建术治疗中的应用价值。方法:回顾性分析8例我科近1年收治的,均经全脑血管造影术(DSA)检查确诊为烟雾病的患者的病例资料。所有患者均行颞浅动脉-大脑中动脉分支吻合术+脑-硬脑膜-肌肉血管融合术(STA-MCA anastomosis combined with encepho-duro-myo-synangiosis,STA-MCA+EDMS)治疗,分别于术前、术后2周行头颅CTP检查。使用飞利浦256层螺旋CT,选取并设定管电压为120KV、管电流150mAs的颅脑灌注扫描模式,同时设定扫描层厚及覆盖范围分别为5mm及12×12cm,单次扫描时间50s。使用碘普罗胺(370mgI/ml)为颅脑成像的对比显影剂,用高压注射器以5ml/s的速率将对比剂经肘静脉注入人体,使用总剂量为50ml。首次扫描可获得300-400幅原始图像,将该原始图像传入到后期处理设备,选用脑灌注软件进行分析处理,选取基底动脉及上矢状窦确定动脉输入函数及静脉输出函数,应用去卷积数学模型获得脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)和达峰时间(TTP)的灌注参数图像。认真观察伪彩图中显示的脑组织缺血部位,并在缺血灶最广的层面勾画出感兴趣的异常灌注区。以镜像方法测量两侧的CBF、CBV、MTT和TTP值,以手术侧参数值比对侧参数值,获得相对CBF(rCBF)、相对CBV(rCBV)、相对MTT(rMTT)和相对TTP(rTTP)。所得数据的整理和分析全部使用SPSS19.0统计学软件,将术前和术后2周对应供血区域的rCBV、rCBF、rMTT、rTTP值进行配对t检验,P0.05为差异有统计学意义。结果:8例行STA-MCA+EDMS联合术式治疗的烟雾病患者,手术前术侧呈现不同程度低灌注,且相比对侧明显;手术治疗后术侧脑血流灌注得到改善,表现为rCBF、rCBV均较术前增加,rMTT较术前缩短,差异有统计学意义(P＜0.05)。手术前后rTTP的改变差异无统计学意义(P0.05)。术后CTA显示搭桥血管无狭窄、闭塞,血流通畅。结论:CT灌注成像能精确显示烟雾病患者脑组织缺血的范围及程度,为术者准确了解病情、选择手术适应症及手术方式提供客观依据;CT灌注成像对评估烟雾病联合血管重建术患者术后脑组织血流灌注的改善及预后有重要意义。
[Abstract]:Objective: to evaluate the value of CT perfusion imaging (CTP) in the treatment of moyamoya disease combined with revascularization. Methods: the data of 8 cases of moyamoya disease diagnosed by whole cerebrovascular angiography (DSA) were retrospectively analyzed. All patients were treated with STA-MCA anastomosis combined with encepho-duro-myo-synangiosis-STA-MCA EDMS before and 2 weeks after operation. Using Philips 256-layer spiral CTs, the scanning mode of brain perfusion was selected and set the voltage of the tube was 120kV and the current of the tube was 150mAs. The thickness and coverage of the scanning layer were 5mm and 12 脳 12cm, respectively, and the scanning time was 50s. Iopramide 370mg I / ml was used as contrast medium for craniocerebral imaging. The contrast agent was injected into human body through elbow vein with high pressure syringe at the rate of 5ml/s. The total dose was 50ml. 300-400 original images were obtained from the first scan. The original images were transferred to the post-processing equipment. The cerebral perfusion software was used to analyze and process, and the basilar artery and the superior sagittal sinus were selected to determine the arterial input function and the venous output function. The perfusion parameters of CBF, CBV, MTT and TTPwere obtained by using deconvolution mathematical model. The ischemic regions of brain tissue were observed carefully and the abnormal perfusion areas of interest were drawn on the widest level of ischemic foci. The MTT and TTP values of CBFV were measured by the mirror image method. The relative CBF rCBF, the relative CBV rCBV, the relative MTTr MTT and the relative TTPr TTP were obtained by comparing the operation side parameters with the side parameters. The data were collected and analyzed by SPSS 19.0 statistical software. The rCBVV rCBFU rMTTT rTTP value corresponding to the blood supply area was compared with the matched t test (P0.05) before and 2 weeks after operation. Results in 8 patients with moyamoya disease treated with STA-MCA EDMS combined operation, there were different degrees of hypoperfusion and significant difference between the two sides before operation, and the cerebral blood flow perfusion was improved after operation, which showed that the increase of rCBF rCBV was shorter than that before operation, and the increase of rCBFU rCBV was shorter than that before operation. The difference was statistically significant (P < 0.05). There was no significant difference in rTTP before and after operation (P 0.05). CTA showed no stenosis, occlusion and smooth blood flow. Conclusion Perfusion imaging with 10% CT can accurately show the extent and extent of cerebral ischemia in patients with moyamoya disease. The selection of operative indications and surgical methods provides objective basis for CT perfusion imaging to evaluate the improvement and prognosis of cerebral blood flow perfusion in patients with moyamoya disease combined with revascularization.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
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本文编号：1992280