DSA参数成像对颈内动脉支架植入术脑血流动力学变化的检测

发布时间：2018-02-11 10:59

本文关键词： 颈内动脉狭窄血流动力学支架植入 DSA 参数成像　出处：《广西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：用DSA参数成像评价颈内动脉狭窄患者CAS前后脑血流动力学的变化，为临床开展CAS提供参考数据。方法：收集一侧颈内动脉重度狭窄患者，经DSA确诊且患者及家属同意行CAS治疗33例，其中男性19例，女性14例，年龄52～75岁，平均年龄64.5±6.4岁。CAS前以颈内动脉狭窄处为中心行正侧位片全脑血管造影，记录心率和血压值，记录有无血管痉挛，CAS后以同样方法造影，保持导管位置、大小、DSA设备相关参数与CAS前一致。图像分析用截图软件和Photoshop图像处理软件相结合对图像进行分析处理，分别选择颈内动脉末端、脑组织及静脉窦的上矢状窦区为感兴趣区，获得各感兴趣区的密度值。利用Excel软件分别求得各感兴趣区的时间—密度（灰度）曲线，，从各曲线中提取峰值、达峰时间、峰值出现时间、平均通过时间、脑循环时间等参数，进行分析研究。结果：1.CAS前后动脉狭窄侧颅内血管显影情况狭窄侧有2例术前造影未见大脑前动脉显影，术后即刻造影大脑前动脉显影清楚；1例术前造影大脑中动脉远端显影浅淡，术后显影清楚。 2.CAS前后脑组织DSA影像变化术后脑组织DSA影像示染色加深，表现在同一术前动脉期观察点观察术后血管造影，有更多的小动脉和毛细血管显影或有小静脉、静脉以及静脉窦显影。33例患者中有19例表现小动脉和毛细血管显影增多，5例静脉显影，3例静脉窦显影，6例影像未见明显变化。 3.CAS前后DSA参数变化颈内动脉ROI区峰值术后大于术前，达峰时间术后小于术前，峰值出现时间术前后差别无统计学意义。脑组织ROI区峰值术后大于术前，达峰时间、峰值出现时间、平均通过时间术后小于术前。静脉窦ROI区峰值术后大于术前，达峰时间、峰值出现时间术后小于术前。脑循环时间术后小于术前，即从术前的（2.41±0.57）s下降至术后的（1.92±0.56）s。 4.CAS后各参数指标改善情况 33例患者术后颈内动脉、脑组织、上矢状窦感兴趣区PV值分别增加了7.43±3.64、1.89±1.26、6.72±9.70，TP值分别缩短了（0.61±0.30）s、（0.64±0.42）s、（0.45±0.64）s；脑组织、上矢状窦感兴趣区TAPV值分别缩短了(0.53±0.56)s、(0.59±0.86)s，MTT值分别缩短（1.08±0.81）s、（0.95±0.82）s；脑循环时间缩短了（0.48±0.73）s。结论：DSA参数成像技术可检测CAS前后脑灌注和脑血流动力学的变化，峰值、脑组织平均通过时间和脑循环时间更为敏感。
[Abstract]:Objective: to evaluate the changes of cerebral hemodynamics in patients with internal carotid artery stenosis before and after CAS by DSA parameter imaging, and to provide reference data for clinical development of CAS. Methods: a total of 33 patients with severe stenosis of the internal carotid artery were treated with CAS, including 19 males and 14 females aged 52 to 75 years, who were diagnosed by DSA and agreed to be treated with CAS. The mean age was 64.5 卤6.4 years. Before CAS, the anterior and lateral radiographic angiography was performed on the stenosis of the internal carotid artery. The heart rate and blood pressure were recorded, and the vasospasm was recorded. The relative parameters of CAS equipment were the same as those before CAS. Image analysis was performed with the combination of capture software and Photoshop image processing software. The end of internal carotid artery and the area of superior sagittal sinus of cerebral tissue and venous sinus were selected as the areas of interest respectively. The time-density curve of each region of interest was obtained by Excel software, and the parameters such as peak value, peak time, peak time, mean transit time, cerebral circulation time were extracted from each curve. Carry on the analysis research. Results 1. Development of intracranial vessels in the stenosis side of the artery before and after CAS. In the stenotic side, the anterior cerebral artery was not developed in 2 cases before operation, the anterior cerebral artery was clearly developed immediately after operation, and the distal part of the middle cerebral artery in 1 case was superficial, and the development was clear after operation. 2. DSA imaging changes of brain tissue before and after CAS. The DSA images of brain tissue showed that the staining deepened after operation, which was observed at the observation point of the same preoperative arterial phase, and there were more arterioles and capillaries developed or venules. Among the 33 cases of venous and venous sinus imaging, 19 cases showed increased arterioles and capillaries in 5 cases, venous angiography in 3 cases and venous sinus imaging in 6 cases, and no obvious changes were found in 6 cases. 3. Changes of DSA parameters before and after CAS. The peak value of ROI in internal carotid artery after operation was larger than that before operation, and the time to peak after operation was less than that before and after operation, and there was no significant difference before and after the operation. The peak value of ROI in brain tissue after operation was longer than that before operation, the peak time and the time of peak value appeared, and the mean transit time was less than that before operation. The peak value of ROI in venous sinus was longer than that before operation, and the peak time was lower than that before operation. The time of cerebral circulation decreased from 2.41 卤0.57 s to 1.92 卤0.56 s after operation. 4. Improvement of parameters after CAS. After operation, the PV values of internal carotid artery, brain tissue and superior sagittal sinus were increased by 7.43 卤3.64t 1.89 卤1.266.72 卤9.70m TP, 0.61 卤0.30mSU 0.64 卤0.42sm 0.45 卤0.64s, TAPV values of brain tissue and superior sagittal sinus area of interest were shortened by 0.53 卤0.56s, 0.59 卤0.86sm and 1.08 卤0.81s / 0.95 卤0.82s, respectively, respectively, and the cerebral circulation time was shortened by 0.48 卤0.73s / s, respectivelyly, the TAPV value of the area of interest to the superior sagittal sinus was shortened by 0.53 卤0.56 ~ 0.56 ~ (?) ~ (?) ~ 0.59 卤0.86 ~ (-1)??? Conclusion the changes of cerebral perfusion and cerebral hemodynamics before and after CAS can be detected by Mr DSA parameter imaging. The peak value, the average transit time of brain tissue and the time of cerebral circulation are more sensitive.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743

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