脑梗死患者全脑血管造影术后即刻头颅CT高密度灶的原因探讨

发布时间：2018-01-20 23:07

  本文关键词： 造影剂增强 CT灌注成像 碘普罗胺 全脑血管造影术 血脑屏障　出处：《广西医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的探讨脑梗死患者全脑血管造影术后即刻头颅CT脑梗死区高密度灶的可能原因。 方法连续收集34例全脑血管造影后即刻头颅CT脑梗死患者,CT高密度灶患者于24小时内复查头颅CT观察高密度灶变化情况。根据CT表现按有无高密度灶分为高密度灶组和无高密度灶组。造影后当天行腰穿检查并留取脑脊液,采用紫外分光光度法检测脑脊液碘普罗胺浓度,比较高密度灶组和无高密度灶组患者脑脊液碘普罗胺浓度有无差异。造影后三天内行脑CTP检查了解梗死区及高密度灶处的血流灌注情况。 结果34例患者中发现CT高密度灶15例,CT高密度灶发生率为44%。高密度灶组和无高密度灶组在性别、年龄、高血压病、糖尿病、心脏病、高血脂症等基线资料比较,差别均无统计学意义。造影后即刻头颅CT高密度灶表现多样,可分别在脑皮质、脑实质、蛛网膜下腔及脑室出现高密度灶,24小时内CT复查高密度灶消退,其中皮质高密度灶3例,放射冠高密度灶2例,基底节区高密度灶6例,混合型高密度灶4例。高密度灶组(n=15)患者的频数分布以脑梗死后第二周、第三周最多；高密度灶组(n=15)和无高密度灶组(n=19)造影过程中造影剂平均剂量分别为104.0±9.5ml和89.2±8.3ml,两组间比较差别有统计学意义(P0.05)。造影剂剂量100ml的11例患者有9例发现高密度灶；造影剂剂量≤100ml的23例患者中有6例发现高密度灶,差别具有统计学意义,造影剂剂量100ml患者较造影剂剂量≤100ml患者高密度灶发生率高(81.8%vs26.1%)。高密度灶组(n=4)和无高密度灶组(n=4)脑脊液碘普罗胺平均浓度分别为209±50ug/ml和29±6ug/ml；高密度灶组碘普罗胺浓度高于无高密度组,差别具有统计学意义(P0.05)。高密度灶组与无高密度灶组患侧CBF、CBV均低于对照侧,MTT、TTP均较对照侧延长,差别均具有统计学意义(P＜0.05)；高密度灶处CBV高于对照侧,CBF低于对照侧,MTT及TTP均较对照侧延长,差别均具有统计学意义(P＜0.05) 结论脑梗死患者全脑血管造影术后即刻头颅CT易出现高密度灶。血脑屏障破坏是脑梗死患者全脑血管造影术后即刻头颅CT高密度灶的可能原因。造影剂神经毒性作用和脑缺血诱导局部血管增生可能是致血脑屏障破坏和造影剂外溢的重要因素。高密度灶处CBV升高,提示CBV可作为反映脑梗死患者全脑血管造影术后CT高密度灶的一项敏感指标。
[Abstract]:Objective to explore the possible causes of high density cerebral infarction in cerebral infarction patients. Methods 34 consecutive patients with cerebral infarction were collected immediately after cerebral angiography. According to the CT findings, the patients were divided into high-density focus group and non-high-density focus group according to CT findings. Keep cerebrospinal fluid. The concentration of iopramide in cerebrospinal fluid was determined by ultraviolet spectrophotometry. The cerebrospinal fluid (CSF) of patients with high density focus and no high density focus were compared. Cerebral CTP examination was performed within 3 days after angiography to find out the blood flow perfusion in the infarcted area and the high density focus. Results the incidence of high density CT focus was 44 in 15 of 34 patients. Sex, age, hypertension, diabetes, heart disease were found in high density focus group and no high density focus group. Hyperlipidemia and other baseline data, the difference was not statistically significant. Immediately after the contrast, CT high-density foci of various manifestations, can be in the cerebral cortex, brain parenchyma, subarachnoid space and ventricle high-density lesions. Within 24 hours CT examination showed that the high-density foci disappeared in 3 cases of cortical hyperdense foci 2 cases of radiation-coronal high-density foci and 6 cases of basal ganglia high-density foci. There were 4 cases of mixed high-density foci. The frequency distribution of the patients in the high-density group was the second week after cerebral infarction and the most in the third week. The average dose of contrast agent was 104.0 卤9.5ml and 89.2 卤8.3ml, respectively. The difference between the two groups was statistically significant (P 0.05). High density foci were found in 9 out of 11 patients with 100 ml contrast agent. Among the 23 patients whose dose of contrast agent 鈮，

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