多排螺旋CT灌注成像及血管成像对蛛网膜下腔出血后脑血流动力学改变的临床研究

发布时间：2019-05-21 20:08

【摘要】：目的：本研究旨在探讨脑血管灌注成像及脑血管造影联合诊断对蛛网膜下腔出血后脑血流动力学改变的临床诊断及应用价值。方法：收集2010年10月～2013年6月期间经牡丹江医学院附属红旗医院内外科收治患者,并筛选经临床诊断符合蛛网膜下腔出血诊断标准及三级以上医院出具的相关影像学检查确诊为蛛网膜下腔出血病人,经CTA检查排除脑动脉、颈动脉狭窄、闭塞等其他影响因素。选取研究组病例93例,其中男性62例,女性31例,平均年龄为63岁。所有患者均为突发性意识障碍,突发或持续性恶心呕吐、头痛、不同程度昏迷、失语、肌力异常、查体颈强直、Kernig征、Brudzinski征等脑膜刺激征。所有入选患者均行64排螺旋CT脑血管造影检查并分别于3、7、10、14天行脑血管灌注成像检查。对所有病例经静脉团注造影剂后,对已选定层面做连续动态采集,并或许相应容积数据并检测该层面内像素的时间—密度曲线,并将数据传输至Vitrea23.9工作站,经数据模型获取感兴趣区的达峰时间(time to peak, TTP)、脑血流量(cerebral blood flow,CBF)、脑血容量(cerebral blood volume,CBV)、平均通过时间(mean transit time,MTT)等数据,通过计算机数模转换器及仿真伪彩技术获得脑组织灌注功能图,用以评价病例SAH后局部脑组织血流灌注情况。所有病例CTA扫描容积数据传至Vitrea23.9工作站后经两名主治或副高职医师采用双盲法对数据进行容积再现(VR)、曲面重建(CPR)、最大密度投影(MIP)重建出大脑动脉环及其3、4级分支,观察脑血管形态变化,并对诊断符合率进行复核诊断。结果：本组全部病例均经过我院主治或副高职以上医师根据图像进行CTA和CTP分析获得。本组病例CTA未能显示脑血管局部痉挛者41例,轻度脑血管痉挛11例,中度脑血管痉挛21例,重度脑血管痉挛20例。于CTA未能显示脑血管局部痉挛的41例病人中,发生脑组织局部低灌注者8例(19.5%),其中发生于脑沟裂残存血凝块附近1例,发生于脑分水岭区7例；3例(27.3%)轻度脑血管痉挛患者发生脑组织低灌注。8例(38.1%)中度脑血管痉挛患者发生脑组织低灌注。16例(80%)重度脑血管痉挛患者发生脑组织低灌注。脑血管痉挛程度与脑组织发生低灌注状态成正相关。结论：1.通过CTA扫描下的MIP可客观反映SAH后患者脑血管走形、分支、及管腔痉挛狭窄程度,通过VR重建可观察血管管壁及腔内情况,并具三维立体的形象效果。对明确患者局部血管管腔狭窄、闭塞情况、确定病变部位和测量狭窄程度作出准确可靠诊断。2.通过CTP扫描,并针对达峰时间的分析,可对脑组织血流灌注情况作出最敏感和早期诊断。3.通过多排螺旋CT灌注成像及血管成像联合应用可对脑组织血流动力学改变从形态学及功能学多方面综合作出全面、定量、定性的全面评价。4.通过CTA联合CTP检查对于SAH后脑血流动力学改变的研究,寻求早期鉴定血管血流动力学显著变化的切实有效方法,为临床医生正确诊断、治疗机判断预后提供影像学依据,具有重要的临床研究意义。
[Abstract]:Objective: The purpose of this study is to investigate the clinical diagnosis and application value of cerebral blood flow dynamic changes after subarachnoid hemorrhage by the combination of cerebrovascular perfusion imaging and cerebral angiography. Methods: During the period from October,2010 to June,2013, the patients were treated with the red flag hospital in Mudanjiang Medical College, and the clinical diagnosis was selected to be in accordance with the diagnosis standard of the subarachnoid hemorrhage and the relevant imaging examination issued by the above three-level hospitals. Human, CTA examination to exclude other effects of cerebral artery, carotid artery stenosis, occlusion, etc. In the study group,93 cases were selected, including 62 males and 31 females, with an average age of 63 Years of age. All patients were of sudden consciousness disorder, sudden or persistent nausea and vomiting, headache, different degree of coma, aphasia, abnormal muscle strength, body neck rigidity, Kernig sign, and Bruzinski's meningeal irritation. Signs: All the enrolled patients underwent a 64-row spiral CT angiography and performed a cerebral perfusion imaging test at 3,7,10 and 14 days, respectively. The time to peak of the region of interest is obtained through the data model, and the time to peak of the region of interest is obtained through the data model. K, TTP, cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and so on. Figure, to evaluate the blood flow perfusion of the local brain after the SAH of the case In all cases, the volume data of CTA in all cases was transferred to Vitrea23.9. The data was reconstructed by double-blind method (VR), surface reconstruction (CPR) and maximum density projection (MIP). The cerebral artery and its 3 and 4 branches were reconstructed by double-blind method. Make a review of the diagnostic accuracy of the diagnosis Results: All the cases of this group were treated by the doctor or the above-mentioned doctors in our hospital according to the image for CTA and CTP. In this group,41 cases of cerebral vasospasm,11 cases of mild cerebral vasospasm,21 cases of moderate cerebral vasospasm and severe cerebral vasospasm were not shown. Of the 41 patients who failed to display the partial cerebral vasospasm,8 (19.5%) of the local hypoperfusion in the brain of the brain, which occurred in 1 case in the vicinity of the residual blood clot in the brain, occurred in the brain watershed. in 7 of that region,3 (27.3%) of the patients with mild cerebral vasospasm had low perfusion in the brain.8 (38.1%) of the patients with moderate cerebral vasospasm had low perfusion in the brain.16 (80%) of the patients with severe cerebral vasospasm had brain tissue Low perfusion. The degree of cerebral vasospasm and the low perfusion state of brain tissue Positive correlation. Conclusion:1. The MIP of the CTA scan can objectively reflect the cerebral blood vessel shape, the branch and the degree of the stenosis of the lumen after the SAH, and the vessel wall and the inside of the cavity can be observed through the reconstruction of VR, and the three-dimensional three-dimensional model can be used. The effect of the image on the stenosis and the occlusion of the local vascular lumen of a clear patient, the determination of the position of the lesion and the degree of the measurement of the stenosis can be accurately by the diagnosis.2. By means of the CTP scan, and for the analysis of the peak time, it is possible to make the most sensitive and early to the blood flow perfusion in the brain tissue 3. Through the combined application of multi-slice spiral CT perfusion imaging and blood vessel imaging, the changes of hemodynamics in brain tissue can be comprehensively, quantitatively and qualitatively analyzed from the aspects of morphology and function. 4. According to the study of the changes of cerebral blood flow dynamics after SAH by the combination of CTA and CTP, an effective and effective method for early identification of the changes in the blood flow dynamics of the blood vessel was sought.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.35

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