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目的探讨多层CT脑灌注技术和头颈部CT灌注成像(CTA)技术联合应用评价颈动脉重度狭窄性病变的临床价值。方法对23例有症状的颈动脉重度狭窄性病变进行颅脑平扫、脑CT灌注和头颈部CTA联合检查。利用CTA对血管的狭窄程度、狭窄部位进行评价,利用CT灌注对脑血流动力学状态进行评价。选10名年龄相匹配的志愿者行CT灌注检查,作为CT灌注的对照组。结果CTA显示一侧颈内动脉闭塞12例,一侧颈内动脉重度狭窄11例。7例为单侧颈内动脉病变,16例为多血管多部位狭窄,包括对侧颈动脉狭窄,单侧或双侧椎动脉狭窄或闭塞,颅内血管狭窄或闭塞。脑CT灌注显示病变同侧灌注异常17例,闭塞组(8例)和重度狭窄组(9例)在灌注异常的发生率上差异无统计学意义。单发组(3例)和多发组(14例)在灌注异常发生率上差异有统计学意义(P<0·05)。结论颈动脉重度狭窄性病变多伴有同侧脑灌注的异常(17/23),多血管病变脑内灌注异常的发生率多于单发的颈动脉狭窄或闭塞。CTA和CT灌注技术联合应用可更加全面地评价颈动脉狭窄性病变,具有较高的临床应用价值。
Objective To investigate the clinical value of multi-slice CT perfusion and CT perfusion imaging of head and neck (CTA) in the evaluation of severe carotid stenosis. Methods Twenty-three patients with symptomatic severe carotid stenosis were examined by brain CT scan, brain CT perfusion and head-and-neck CTA. CTA was used to evaluate the degree of stenosis and stenosis of the blood vessels, and CT perfusion was used to evaluate the cerebral hemodynamics. Ten age-matched volunteers underwent CT perfusion examination as a control group for CT perfusion. Results CTA showed that one side of internal carotid artery occlusion in 12 cases, one side of severe carotid artery stenosis in 11 cases. Seven patients had unilateral internal carotid artery lesions and 16 had multi-site stenosis of multiple vessels including contralateral carotid artery stenosis, unilateral or bilateral stenosis or occlusion of the vertebral artery, stenosis or occlusion of intracranial blood vessels. Brain CT perfusion showed ipsilateral perfusion abnormalities in 17 cases, occlusion group (8 cases) and severe stenosis group (9 cases) in the incidence of perfusion difference was not statistically significant. There was significant difference in the incidence of perfusion between single group (3 cases) and multiple group (14 cases) (P <0.05). Conclusion Severe carotid stenosis is associated with ipsilateral cerebral perfusion abnormalities (17/23). The incidence of intracerebral perfusion abnormalities in multi-vessel disease is more than that of single carotid artery stenosis or occlusion. CTA and CT perfusion techniques can be more comprehensive evaluation of carotid stenosis, with high clinical value.