【摘要】 目的 探讨容积灌注CT血管成像（VPCTA）评价颅内次级侧支循环的可行性。方法 选取疑似脑卒中患者59例，均行一站式头颈部CT血管成像（CTA）+脑部CT灌注（CTP）检查，VPCTA图像从CTP原始数据容积包中获取，分别对VPCTA及脑部单时相CT血管成像（sCTA）的图像质量进行评价；剔除非脑卒中患者，明确脑卒中责任血管，选取VPCTA、sCTA以及两者经后处理技术重建的最大密度投影图像，评估前循环脑卒中患者软脑膜侧支循环情况。结果 59例疑似脑卒中患者413个初级侧支循环（Willis环）动脉节段纳入评估，VPCTA图像质量评分较sCTA低（P<0.05）。根据图像质量主观评分分为非诊断性结果和诊断性结果，VPCTA与sCTA的诊断意见比较差异均无统计学意义（P均>0.05）。VPCTA与sCTA对前循环脑卒中患者软脑膜侧支循环评价比较差异有统计学意义（P<0.05），后者存在高估现象。结论 VPCTA可用于评估颅内次级侧支循环，并可对sCTA在评价前循环脑卒中软脑膜侧支循环的高估现象进行有效矫正，有可能替代sCTA。更多还原

【Abstract】 Objective To explore the feasibility and advantages of volume perfusion computed tomography angiography(VPCTA) in detecting intracranial secondary collateral circulation. Methods Fifty-nine patients with suspected stroke were selected. All of them underwent one-stop head and neck CTA + computed tomography perfusion(CTP) of the brain. VPCTA images were obtained from the original data volume package of CTP. The image qualities of VPCTA and single-phase computed tomography angiography(sCTA) of the brain were evaluated respectively. Excluding non-stroke patients, the responsible blood vessels for stroke were identified. VPCTA, sCTA, and the maximum intensity projection(MIP) images reconstructed by post-processing techniques of both were selected to evaluate the collateral circulation of the pia mater in patients with anterior circulation stroke. Results A total of 413 primary collateral circulation(Willis circle) arterial segments of 59 suspected stroke patients were included in the assessment, and the VPCTA image quality score was lower than that of sCTA(P < 0.05). The scoring results were classified into non-diagnostic and diagnostic results based on whether they had diagnostic value. There was no statistically significant difference in the diagnostic opinions between VPCTA and sCTA(all P > 0.05). There was a statistically significant difference in the evaluation of collateral leptomeningeal circulation between VPCTA and sCTA in patients with anterior circulation stroke(P < 0.05), and the latter showed an overestimation phenomenon. Conclusion VPCTA can be used to evaluate intracranial collateral circulation, which can effectively correct the overestimation phenomenon of sCTA in evaluating leptomeningeal collateral circulation in the anterior circulation of stroke collateral circulation and replace sCTA.更多还原