【作者】 李强；

【导师】 刘晓晟；

【作者基本信息】 上海交通大学 ， 影像医学与核医学， 2015， 硕士

【摘要】 目的:应用CTA和CTP联合评估单侧颈动脉狭窄患者的脑灌注及侧枝血流循环情况,并探讨症状组及无症状组患者的脑灌注差异,以及单侧重度颈动脉狭窄患者侧枝代偿类型与临床表现之间的联系。方法:回顾性收集在仁济医院神经外科行CTA联合CTP检查的76例单侧颈动脉重度狭窄(狭窄率>70%且对侧<50%)的患者,按照临床及影像学表现分为无症状组(30例)及症状组(46例),分别计算患侧/健侧MCA供血区的各灌注参数,包括CBV、CBF、MTT及TTP,并计算相对应的r CBV、r CBF、d MTT、d TTP,比较两者灌注差异,并依据CTA对两组患者的侧枝代偿类型以及willis环开放情况进行评估。结果:1、两组患者脑灌注比较,无症状组与症状组r CBF、d MTT、d TTP均有显著差异,r CBV无显著差异。2、初级侧枝循环的开放比例中,症状组明显小于无症状组,差异有显著性(p=0.017);次级侧枝循环开放的比例中,症状组大于无症状组,差异有显著性(p=0.022),初级次级侧枝共同开放比例中,症状组大于无症状组,差异有显著性(P=0.027);3、前交通动脉开放比例中,症状组大于无症状组,差异有显著性(p=0.013);后交通动脉开放比例中,症状组与无症状组无显著差异(p=0.382)。结论:1、两组术前r CBF、d MTT、d TTP有显著差异,提示症状组术前有更显著的脑血流损害。2、单侧重度颈动脉狭窄患者侧枝代偿情况与临床症状密切相关,初级侧枝循环是颅内最早期也是最主要的侧枝循环代偿方式,次级侧枝循环的出现通常表明颅内存在较为严重的脑缺血。3、在初级代偿中,前交通动脉开放与脑缺血症状的发生更为密切,后交通动脉代偿与脑缺血症状的发生无显著相关性。背景和目的:颈动脉支架置入术已成为治疗颈动脉狭窄的一种安全可靠的手术,且目标人群已经扩大到无症状的重度颈动脉狭窄患者。本研究运用CT灌注成像联合CTA以评价无症状组及症状组行支架术后的脑灌注变化,并比较二组间差异。材料与方法:回顾性收集59例单侧重度狭窄(狭窄率>70%且对侧<50%)并行颈动脉支架置入术的患者,其中无症状组23例,症状组36例,患者均在术前1周、术后1周行CT灌注联合CTA检查。分别计算患侧/健侧MCA供血区的各灌注参数,包括CBV、CBF、MTT及TTP,并计算相对应的r CBV、r CBF、d MTT、d TTP。评价两组患者支架术后脑血流动力学的变化情况,并比较无症状组和症状组之间的差异。结果:1、组内比较:症状组患者术后各灌注参数均有显著改善:r CBF(0.84±0.03)增加,r CBV(1.03±0.04)下降,d MTT(1.46±0.22)降低,d TTP(2.38±0.20)降低。无症状组术后d TTP(1.21±0.26)降低,r CBV、r CBF及d MTT无显著变化。2、组间比较,术后r CBV有显著差异(p=0.03),其他参数对比无显著差异。以上以P<0.05为统计学标准。结论:1、颈动脉支架置入术均明显改善了两组患者的脑血流灌注;2、术前症状组存在代偿性脑充血(r CBV>1),术后r CBV较无症状组有显著降低(r CBV<1),这可能是由术后侧枝循环的血流明显减少导致。更多还原

【Abstract】 Objective: application of CTA and CTP joint assessment unilateral carotid artery stenosis in patients with cerebral perfusion and collateral blood flow circulation situation, and discusses the differences of cerebral perfusion between symptomatic group and asymptomatic group, and unilateral collateral compensatory type patients with severe carotid stenosis, the connection between the clinical manifestations.Methods: retrospectively collected in the hospita,neurosurgery joint CTP and CTA examination of 76 cases of severe unilateral carotid artery stenosis(stenosis rate > 70% and the contralateral < 50%) of patients, according to the clinical and imaging findings in asymptomatic groups(30 cases) and the symptom group(46 cases), are calculated respectively with side/health side the perfusion parameters of MCA blood supply area, including CBV, CBF, determined by MTT and TTP, and calculate the corresponding r CBV, r CBF, d MTT, d TTP, compare the two perfusion, and on the basis of CTA collateral compensatory type in two groups of patients, and assess Willis ring opening.Results: 1, the comparison of two groups of patients with cerebral perfusion, asymptomatic group with the symptomatic of r CBF, d MTT, d TTP all have significant differences, r CBV there was no significant difference. 2, the primary collateral circulation in the proportion of open, symptomatic are much smaller than asymptomatic group, with significant difference(p =0.017). Subprime collateral circulation in proportion to the open, the symptom is greater than the asymptomatic group, with significant difference(p = 0.022), common open junior secondary collateral ratio, the symptom is greater than the asymptomatic group, with significant difference(p = 0.027). 3,For opening ratio of the fore-communicating artery, the symptomic group is greater than the asymptomatic group, with significant difference(p = 0.013). For opening ratio of the posterior-communicating artery, symptomatic group and asymptomatic group have no significant difference(p = 0.382).Conclusion: 1, two groups of preoperative r CBF, d MTT, d TTP have significant differences, prompt preoperative symptomatic group has more significant damage of the cerebral blood flow. 2, unilateral collateral compensatory in patients with severe carotid stenosis is closely related to the clinical symptomatic, primary intracranial collateral circulation is the early and the main way of collateral circulation compensatory, subprime collateral circulation appears usually indicates intracranial exist serious cerebral ischemia. 3, in the primary compensatory, the opening of fore-communicating artery is more closely with the incidence of ischemic symptomaticatic, there was no significant correlation with the opening of the posterior-communicating artery and incidence of ischemic symptomsBackground and objective: Carotid artery stenting has become a safe and reliable procedure in the treatment of carotid artery stenosis, and its target population has expanded to severe carotid artery stenosis patients without cerebral infarction. In this paper, CT perfusion imaging combined with CTA was used to evaluate the changes in cerebral perfusion after stenting in the non-cerebral infarction group and the cerebral infarction group respectively, followed by comparison of the differences between them.Materials and methods: Fifty-nine patients with unilateral severe stenosis(stenosis rate>70% and the contralateral side< 50%), who underwent carotid artery stenting, were retrospectively collected with 23 cases in the non-cerebral infarction group and 36 cases in the cerebral infarction group. CT perfusion imaging combined with CTA was performed in all patients at one week before and after the surgery. The perfusion parameters of MCA supplying area at the affected side/the healthy side, including CBV, CBF, MTT and TTP, as well as their corresponding r CBV, r CBF, d MTT and d TTP, were calculated respectively. Based on the evaluation of changes in cerebral hemodynamics after stenting, the differences were compared between the non-cerebral infarction group and the cerebral infarction groupResults: Intra-group comparison showed that the perfusion parameters in the patients of the cerebral infarction group were significantly improved, with increased r CBF(0.84±0.03) and reduced r CBV(1.03±0.04), d MTT(1.46±0.22), and d TTP(2.38±0.20). After surgery, d TTP(1.21±0.26) was reduced in the non-cerebral infarction group, while no significant changes in r CBV, r CBF and d MTT were reported. The inter-group comparison showed that the differences in preoperative r CBF, d MTT and d TTP were statistically significant whereas the difference in postoperative r CBV was statistically significant, where all of P values were <0.05. The differences in other parameters were not statistically significant.Conclusion: 1) Carotid artery stenting significantly improves the cerebral blood perfusion in both groups; 2) compared with the non-cerebral infarction group, the significantly lower postoperative r CBV in the cerebral infarction group indicates the presence of impaired cerebral blood flow autoregulation in the cerebral infarction group;更多还原