中国医学影像技术2006年第22卷第8期　ChinJMedImagingTechnol,2006,Vol22,No8 1155

中枢神经影像学

StudyonmiddlecerebralarterystenosisorocclusionbyCTperfusion

andCTangiographywith642detectorrowCT

GAOYan,LIKun2cheng

3

,DUXiang2ying,LIUJia2bin,YANGYan2hui

(DepartmentofRadiology,XuanwuHospital,CapitalyofB,China)

[Abstract]　Objective　ToevaluatetheapplicationCT)CTangiography(CTA)of642detectorrowCT()orocclusionofmiddlecerebralartery(MCA).stenosisorocclusionofMCAdiagnosedbyDSAand10normaladultbyCT,theunenhancedaxialCT,CTPandCTAwereperformed.Todiscriminatetheischemic,mapsofcerebralbloodflow(CBF),cerebralbloodvolume(CBV),meantransittime(MTT)andtimetopeak(TP)wereobtained.Results　AccordingtoMTTandTPmapsofCTP,thecerebralperfusionde2laywasdividedintothreetypes:typeⅠ,thelesiononlyinvolvedtheMCAterritory;typeⅡ,thelesiononlyinvolvedtheboundaryzone;andtypeⅢ,thelesioninvolvedthebothMCAterritoryandboundaryzone.In25patientswithunilateralstenosisorocclusionofMCA,4patientsofCTPwerenormal,thetypeⅠcerebralperfusiondelaywasdepictedonCTPmapsin17cases,andthetypeⅢcerebralperfusiondelaywasseenin4cases.Comparingwithnormalcontrolgroup,therewereMTTandTPdelay,CBFdecreaseandCBVincreaseinbilateralMCAterritoryin12caseswithseverestenosisofbilat2eralMCA.Thesechangesindicatedthebilateralischemiaofbrain.ThecollateralcirculationcoulddecreasethedamageofsymptomaticsideofcerebralperfusioninthecaseswithunilateralstenosisofMCA,butnomatterwithorwithoutcollateralcirculation,bilateralbraindamagewerealsosevereforthepatentswithsignificantstenosisandocclusionofbilateralMCA.Conclusion　MTTandTPweresensitivetodepicttheperfusiondamageofbraincausedbyMCAseverestenosisorocclu2sion,andplayanimportantroleindiagnosis,treatmentofcerebralischemia,andpreventionofcerebralinfarct.[Keywords]　Middlecerebralartery;Stenosis;Occlusion;CTperfusion;CTangiography

64排螺旋CT脑灌注和CT血管成像在大脑中

动脉狭窄或闭塞的应用

高　艳,李坤成3,杜祥颖,刘佳宾,杨延辉

(首都医科大学宣武医院医学影像学部放射科,北京　100053)

[摘　要]　目的　评价64排螺旋CT脑灌注(CTP)联合头颈部CT血管成像(CTA)检查对大脑中动脉(MCA)狭窄或闭塞

所致脑缺血的临床应用价值。方法　对37例经DSA诊断为单、双侧MCA狭窄或闭塞患者及10名正常成年志愿者分别进行螺旋CT头颅平扫、CTP和CTA检查。脑CTP检查获得脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TP)等参数值,判断脑缺血。结果　按照脑CTP的MTT和TP图将脑灌注延迟表现分为三型:Ⅰ型病变仅累及

MCA区,Ⅱ型病变仅累及分水岭区,Ⅲ型病变同时累及MCA和分水岭区。①在25例单侧MCA狭窄/闭塞患者中,4例CTP正常,17例脑CTP灌注延迟区为Ⅰ型,4例为Ⅲ型。②与正常对照组相比,12例双侧大脑中动脉重度狭窄患者的双侧MCA支配区均有MTT和TP延迟,CBF下降和症状侧CBV升高的异常改变,提示为双侧脑缺血。侧支循环能明显减少

单侧MCA狭窄患者的症状侧的脑灌注损伤,但对双侧MCA重度狭窄和闭塞患者,无论有无侧支循环,双侧脑组织灌注损伤都很严重。结论　脑CTP检查的MTT和TP图能敏感显示MCA重度狭窄或闭塞所致的脑灌注损伤,为脑缺血的诊断、治疗及预防脑梗死均具有重要价值。

[关键词]　大脑中动脉;狭窄;闭塞;CT灌注;CT血管成像

[中图分类号]　R743.3;R814.42　[文献标识码]　A　　[文章编号]　100323289(2006)0821155204

[作者简介]高艳(1970-),女,北京人,研究生,副主任医师。E2mail:wsggy518@sina.com

[通讯作者]李坤成,首都医科大学宣武医院医学影像学部放射科,100053。E2mail:likuncheng1955@yahoo.com.cn[收稿日期]2006204227　　[修回日期]2006208205