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目的探讨双源CT灌注成像评价颈内动脉粥样硬化患者脑血流动力学改变的临床应用价值。方法对2012年1月-2013年5月间就诊的30例经过CT血管造影检查确诊颈内动脉粥样硬化所致管腔不同程度狭窄或闭塞患者行全脑灌注成像,分别重建CT灌注成像(CTPI)参数图,包括脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)及达峰时间(TTP)评估脑组织灌注情况。结果 30例颈内动脉粥样硬化患者中,管腔轻度狭窄8例,中度狭窄12例,重度狭窄7例,闭塞3例。狭窄侧与对侧相比,轻度狭窄患者TTP延长(P<0.05),其余各灌注参数差异均无统计学意义(P>0.05);中度狭窄患者狭窄侧MTT、TTP高于对侧(P<0.05);重度狭窄或闭塞患者狭窄侧CBF、CBV低于对侧,MTT、TTP高于对侧(P<0.05)。30例中22例存在灌注异常。结论 CTPI能早期综合性反映脑组织灌注情况,能全面反映颈内动脉粥样硬化所致重度狭窄或闭塞对脑血流动力学变化,为临床治疗提供重要信息,也有利于临床医师制订个体化治疗方案。
Objective To investigate the clinical value of dual-source CT perfusion imaging in the evaluation of cerebral hemodynamics in patients with internal carotid atherosclerosis. Methods Thirty patients with different degrees of stenosis or occlusion of internal carotid artery atherosclerotic lesions confirmed by CT angiography during January 2012 to May 2013 were performed whole brain perfusion imaging to reconstruct CT perfusion imaging (CTPI) parameters, including cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT) and peak time (TTP) Results Among the 30 patients with internal carotid atherosclerosis, there were 8 mild stenosis, 12 moderate stenosis, 7 severe stenosis and 3 occlusion. TTP in the patients with mild stenosis was longer in the stenosis side than in the contralateral side (P <0.05), and there was no significant difference in other parameters of perfusion (P> 0.05). The stenosis side MTT and TTP in the stenosis side were higher than those in the contralateral side P <0.05). The stenosis side of severe stenosis or occlusion had lower CBF and CBV than the contralateral side and MTT and TTP higher than contralateral (P <0.05). Twenty-two of 30 patients had perfusion abnormalities. Conclusion CTPI can early comprehensive reflect the perfusion of brain tissue, can fully reflect the internal carotid artery atherosclerosis caused by severe stenosis or occlusion on cerebral hemodynamic changes for the clinical treatment to provide important information, but also conducive to the development of individual physicians Treatment programs.