【摘要】 目的应用CT灌注成像(CT perfusion,CTP)对急性自发性高血压出血性脑卒中(acute spontaneously hy-pertensive intracerebral hemorrhage,shICH)血肿周围脑血液动力学变化进行定量研究,验证血肿周围是否存在缺血半暗带。方法对26例(男22例,女4例,年龄33～74岁,平均55.08岁)临床及CT确诊为幕上shICH患者行CTP检查,自发病到灌注扫描的时间为8～19h,平均14.88h。以血肿最大层面为参照,测量血肿内部、血肿周围、远隔区及对侧镜像区脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT),并计算相对灌注参数值rCBF、rCBV、rMTT(患侧/健侧)。结果 shICH血肿灌注参数伪彩图从血肿中心到外周色差呈阶梯样分布。血肿周围组CBV值为(1.61±1.53)ml.100g-1、CBF值为(16.48±17.38)ml.100g-1.min-1),低于对侧镜像区(Z CBV=-2.603、Z CBF=-4.178,P<0.05);MTT值为(9.12±2.57)s,较对侧镜像区延长(t=4.747,P<0.05)。方差分析显示血肿内部、血肿周围组及远隔区组灌注参数MTT及相对值rCBF、rCBV、rMTT均数间差异有统计学意义(FMTT=9.043、FrCBV=38.031、FrCBF=25.023、FrMTT=12.486,P<0.05),进一步LSD分析,血肿周围组与远隔区组MTT、rMTT、rCBF差异有统计学意义(P<0.05),但两组间rCBV值无统计学差异(P>0.05)。且秩和检验显示血肿周围组CBF明显低于远隔区组(Z=-2.288,P<0.05),但两组间CBV均值差异无显著性(Z=-0.357,P>0.05)。结论 CTP可反应shICH血肿周围低灌注状态,但没有证据显示存在缺血半暗带。更多还原

【Abstract】 Objective To quantify hemodynamic changes in patients with acute spontaneous hypertensive intracerebral hemorrhage(shICH) using computed tomography perfusion(CTP) imaging.Methods 26 patients(22 men and 4 women,age range 33～74,mean age 55.08 years) who suffered from a supratentorial shICH,were at admission and received CTP scanning within 8～19 h(mean 14.88 h) after symptom onset.At the maximum levels of the hematoma,cerebral blood flow(CBF),cerebral blood volume(CBV) and mean transit time(MTT) were measured in three different regions of interest(ROI)manually outlined on CT scan: ① hemorrhagic core(hyperdense on unenhanced CT image);② perihematomal area(isodense within 1 cm rim of perilesion area);③ normal area far from ipsilateral hemorrhage,and ④ a mirrored area(CBVn,CBFn,MTTn),including the clot and the perihematomal region located in the contralateral hemisphere.rCBF,rCBV,rMTT were calculated(rCBV=CBV/CBVn,rCBF=CBF/CBFn,rMTT=MTT/MTTn).ResultsThe CBF,CBV,and MTT color maps showed a centrifugal distribution with a gradual improvement from the core of hematoma to the periphery.The CBV,CBF,and MTT value of perihematoma area were(16.48±17.38) ml·100g-1·min-1),(1.61±1.53) ml·100g-1),(9.12±2.57) s,respectively.There was significantly decreased CBF,CBV and prolonged MTT in perihematomal group against contralateral mirrored area(ZCBV=-2.603,ZCBF=-4.178,tMTT =4.747,P<0.05).Variance analysis showed the difference of the perfusion parameters,including MTT,rCBF,rCBV,rMTT,among intrahematoma,perihematoma group and the remote areas was significant(FMTT=9.04,FrCBF=25.02,FrCBV=38.03,FrMTT=12.49,P<0.05).The values of MTT,rMTT,rCBF between perihematomal group and remote area had statistically difference by LSD analysis(P<0.05),but there was no statistically difference of rCBV between the two groups(P>0.05).Mean CBF value of perihematomal group was lower than that of remote area(Z=-2.288,P<0.05),but the difference of mean CBV in the two groups was not statistical significant(Z=-0.357,P>0.05).Conclusion Multi-parametric CTP imaging can indicate low perfusion states around hematoma in acute shICH patients,but there is no evidence of ischemic penumbra.更多还原