| 摘要: |
| 目的探讨 320 排 CT 在单侧大脑中动脉（MCA）闭塞患者血流动力学改变及侧支循环评估中的应用价值，以及对预 后的评价作用。 方法 对 63 例单侧 MCA 闭塞患者行 320 排 CT 头颈联合多参数扫描，获取常规 CT 血管造影（CTA）、4D-CTA 及 脑灌注图像，分析常规 CTA 和 4D-CTA 图像的侧支状况，计算侧支循环评分与预后的相关性，并比较侧支循环良好组和侧支循环不 良组的脑灌注差异。 结果 在 4D-CTA 上侧支循环良好者 40 例（63.5%），而在常规 CTA 上仅 25 例（39.7%）。基于 4D-CTA 的侧支 循环评分与 90d 改良 Rankin 量表评分呈负相关（r=-0.616，P＜0.01）。侧支循环良好组患侧的相对脑血流量及相对脑血容量均高于 侧支循环不良组（均 P＜0.01）。两组患侧的相对平均通过时间及相对平均达峰时间差异均无统计学意义（均 P ＞0.05）。 结论 320 排 CT 是评价单侧 MCA 闭塞患者脑血流动力学改变和侧支循环建立情况的有效方法，4D-CTA 成像评估侧支血流和预测预后较常规 CTA 更好。 |
| 关键词: 大脑中动脉 侧支循环 体层摄影术 X 线计算机 灌注成像 血管成像 |
| DOI： |
| 分类号: |
| 基金项目:浙江省医药卫生科技计划项目 |
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| Evaluation of cerebral hemodynamic changes and collateral circulation in patients with unilateral middle cerebral artery occlusion by 320-row-detector CT scan |
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CHEN Junfa, YUAN Jianhua, SONG Qiong, XU Jian, WANG Zhen, LUO Zuyan
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Zhejiang Provincial People’s Hospital
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| Abstract: |
| Objective To investigate the cerebral hemodynamic changes and collateral circulation in patients with unilateral middle cerebral artery (MCA) occlusion by 320-row-detector CT scan. Methods The data of the dynamic CT angiography (4D-CTA), conventional single-phase CTA and CT brain perfusion were acquired in 63 patients with unilateral MCA occlusion. Collateralization was assessed in both conventional CT angiography and dynamic CT angiography by using collateral grading score. Clinical outcomes (modified Rankin Scale) were assessed at 3-month follow-up, and the correlation of clinical outcome with the collateral flow score were analyzed. Collateral status was rated as good (≥50%) and poor (＜50%) of collaterals. Comparisons were made between the results of the two groups in CTP. Results According to 4D-CTA results 40 patients (63.5% )were classified as good collateral circulation, while there were only 25 cases (39.7% ) as good collateral circulation on conventional CTA. There was a negative correlation between the distribution of mRS at 90 days and collateral flow score on 4D-CTA (r=-0.616, P＜0.001). The relative cerebral blood volume and cerebral blood flow in the affected side of patients with good collateral circulation were higher than those with poor collateral circulation(P＜0.01), but there was no significant difference in relative mean transit time and time to peak between two groups(P ＞0.05). Conclusion 320-row-detector CT scan is an effective way for analyzing the cerebral hemodynamic changes and collateral circulation in patients with unilateral middle cerebral artery occlusion. Compared with conventional CTA, 4D-CTA has higher diagnostic value in evaluating collateral circulation and predicting clinical outcome. |
| Key words: Middle cerebral artery Collateral circulation Tomography X-ray computer Perfusion imaging Angiography |
