CT灌注成像对症状性烟雾病综合征血流动力学的评价研究
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摘要
目的探讨CT灌注成像(CTP)在评价症状性烟雾病综合征(s MMS)血流动力学中的应用价值。方法回顾性分析行颅脑CTP检查的64例s MMS患者,对患者双侧额叶、颞叶、基底节区感兴趣区进行定量及定性分析,并对症状侧与非症状侧各相对灌注值(rCBF、rCBV、rTTP及rMTT)进行对比分析。结果 s MMS患者症状侧与非症状侧灌注值比较显示:症状侧颞叶及基底节区rCBF值明显降低,rTTP及rMTT值明显延迟。亚组分析显示:对于单侧s MMS,额叶各CTP参数比较均无明显统计学差异;症状侧颞叶及基底节区rTTP值、rMTT值明显延迟,而rCBF值无明显统计学差异;症状侧基底节区rCBV较对侧明显增加。对于双侧s MMS,症状侧额叶、颞叶及基底节区rCBF值明显降低,颞叶及基底节区rTTP及rMTT值明显延迟。结论 CTP能够直观、定量地评价s MMS患者脑血流动力学变化,为临床提供重要的脑组织灌注信息。
Objective To evaluate the utility of CT perfusion(CTP) forthe assessment of cerebral hemodynamic changes in patients with Moyamoya syndrome(MMS). Methods 64 consecutive MMS patients who received CTP were retrospectively studied. The relative perfusion parametervalues of symptomatic-side were compared to the non-symptomatic-side. Region of interests(ROIs) were chosen in the mirroring bilateral frontal lobes,temporal lobes and basal ganglia. Results The rCBF values of symptomatic-side in the temporal lobes and basal ganglia area were significantly lowerthan the non-symptomatic-side. Meanwhile,the rTTP value and rMTT value of symptomatic-side were significantly delayed. In patients(n = 15) with unilateral s MMS,the differences of all parameters were not significant in the mirroring bilateral frontal lobes. The rTTP value and rMTT value of symptomatic-side in temporal lobes and basal ganglia area were significantly delayed compared to the non-symptomatic-side. However,rCBF values in temporal lobes and basal ganglia areas of symptomatic-side were not significant compared to the non-symptomaticside. The rCBV values of symptomatic-side in the basal ganglia area were significantly higherthan the non-symptomatic-side. In patients(n = 49) with bilateral s MMS,the rCBF values of symptomatic-side in the frontal lobes,temporal lobes and basal ganglia area were significantly lowerthan the non-symptomatic-side. The rTTP value and rMTT value of symptomatic-side in the temporal lobes and basal ganglia area were significantly delayed. Conclusion This study demonstrates that CTP can provide a crucial quantitative and visually assessment of cerebral hemodynamic changes in patients with symptomatic Moyamoya syndrome.
Objective To evaluate the utility of CT perfusion(CTP) forthe assessment of cerebral hemodynamic changes in patients with Moyamoya syndrome(MMS). Methods 64 consecutive MMS patients who received CTP were retrospectively studied. The relative perfusion parametervalues of symptomatic-side were compared to the non-symptomatic-side. Region of interests(ROIs) were chosen in the mirroring bilateral frontal lobes,temporal lobes and basal ganglia. Results The rCBF values of symptomatic-side in the temporal lobes and basal ganglia area were significantly lowerthan the non-symptomatic-side. Meanwhile,the rTTP value and rMTT value of symptomatic-side were significantly delayed. In patients(n = 15) with unilateral s MMS,the differences of all parameters were not significant in the mirroring bilateral frontal lobes. The rTTP value and rMTT value of symptomatic-side in temporal lobes and basal ganglia area were significantly delayed compared to the non-symptomatic-side. However,rCBF values in temporal lobes and basal ganglia areas of symptomatic-side were not significant compared to the non-symptomaticside. The rCBV values of symptomatic-side in the basal ganglia area were significantly higherthan the non-symptomatic-side. In patients(n = 49) with bilateral s MMS,the rCBF values of symptomatic-side in the frontal lobes,temporal lobes and basal ganglia area were significantly lowerthan the non-symptomatic-side. The rTTP value and rMTT value of symptomatic-side in the temporal lobes and basal ganglia area were significantly delayed. Conclusion This study demonstrates that CTP can provide a crucial quantitative and visually assessment of cerebral hemodynamic changes in patients with symptomatic Moyamoya syndrome.
引文
[1]Research Committee on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis; Health Labour Sciences Research Grant for Research on Measures for Infractable Diseases.Guidelines for diagnosis and treatment of moyamoya disease(Spontaneous Occlusion of the Circle of Willis)[J]. Neurol Med Chir(Tokyo),2012,52(5):245-266.
[2]Kim T,Bang JS,Kwon OK,et al. Hemodynamic changes after unilateral revascularization for moyamoya disease:serial assessment by quantitative magnetic resonance angiography[J]. J Congress of Neurological Surgeons,2017,81(1):111-119.
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[4]Togao O,Mihara F,Yoshiura T,et al. Cerebral hemodynamics in Moyamoya disease:correlation between perfusion-weighted MR imaging and cerebral angiography[J]. AJNR,2006,27(2):391-397.
[5]Lin Wang,Cong Qian. Indirect bypass surgery may be more beneficial for symptomatic patients with Moyamoya disease at early suzuki stage[J]. J World Neurosurg,2016,95(11):304-308.
[6]张军,王剑虹,耿道颖,等.采用256层CT全脑灌注研究烟雾病术后桥血管再通及手术前后脑血流动力学的变化[J].中华放射学杂志,2011,45(8):743-746.
[7]陈劲草,刘斌,李正伟,等. CT灌注成像对烟雾病行脑血管重建术的疗效评价[J].中华神经外科杂志,2009,25(6):537-540.
[8]Li Z,Zhou P,Xiong Z,et al. Perfusion-weighted magnetic resonance imaging used in assessing hemodynamics following superficial temporal artery-middle cerebral artery bypass in patients with Moyamoya disease[J]. Cerebrovasc Dis,2013,35(5):455-460.
[9]耿万杰,李正侠.单侧烟雾病临床特点的分析[J].临床荟萃,2012,7(6):520-522.
[10]Ogata T,Yasaka M,Inoue T,et al. The clinical features of adult unilateral moyamoya disease:does it have the same clinical characteristics as typical moyamoya disease?[J]. Cerebrovasc Dis,2008,26(3):244-249.
[11]Kluytmans M,van der Grond J,van Everdingen KJ,et al. Cerebral hemodynamics in relation to patterns of collateral flow[J].Stroke,1999,30(7):1432-1439.
[12]卢洁,李坤成,张苗,等. 64层螺旋CT脑灌注联合CT血管造影在短暂性脑缺血发作的应用[J].中华老年心脑血管病杂志,2006,8(12):806-809.
[13]张亚男,薛静,高培毅,等.单侧烟雾病大脑中动脉供血区血管情况与灌注状态的相关性研究[J].医学影像学杂志,2014,24(10):1669-1673.
[14]王斌,朱凤,周茜萍,等.运用MR血管成像及灌注加权成像评价烟雾病责任血管、术后重建血管及手术前后脑血流动力学变化[J].中华放射学杂志,2014,48(5):381-385.
[15]Dai DW,Zhao WY,Zhang YW,et al. Role of CT perfusion imaging in evaluating the effects of multiple burr hole surgery on adult ischemic Moyamoya disease[J]. Neuroradiology, 2013, 55(12):1431-1438.
[2]Kim T,Bang JS,Kwon OK,et al. Hemodynamic changes after unilateral revascularization for moyamoya disease:serial assessment by quantitative magnetic resonance angiography[J]. J Congress of Neurological Surgeons,2017,81(1):111-119.
[3]Cho WS,Chung YS,Kim JE,et al. The natural clinical course of hemodynamically stable adult moyamoya disease[J]. J Neurosurg,2015,122(1):82-89.
[4]Togao O,Mihara F,Yoshiura T,et al. Cerebral hemodynamics in Moyamoya disease:correlation between perfusion-weighted MR imaging and cerebral angiography[J]. AJNR,2006,27(2):391-397.
[5]Lin Wang,Cong Qian. Indirect bypass surgery may be more beneficial for symptomatic patients with Moyamoya disease at early suzuki stage[J]. J World Neurosurg,2016,95(11):304-308.
[6]张军,王剑虹,耿道颖,等.采用256层CT全脑灌注研究烟雾病术后桥血管再通及手术前后脑血流动力学的变化[J].中华放射学杂志,2011,45(8):743-746.
[7]陈劲草,刘斌,李正伟,等. CT灌注成像对烟雾病行脑血管重建术的疗效评价[J].中华神经外科杂志,2009,25(6):537-540.
[8]Li Z,Zhou P,Xiong Z,et al. Perfusion-weighted magnetic resonance imaging used in assessing hemodynamics following superficial temporal artery-middle cerebral artery bypass in patients with Moyamoya disease[J]. Cerebrovasc Dis,2013,35(5):455-460.
[9]耿万杰,李正侠.单侧烟雾病临床特点的分析[J].临床荟萃,2012,7(6):520-522.
[10]Ogata T,Yasaka M,Inoue T,et al. The clinical features of adult unilateral moyamoya disease:does it have the same clinical characteristics as typical moyamoya disease?[J]. Cerebrovasc Dis,2008,26(3):244-249.
[11]Kluytmans M,van der Grond J,van Everdingen KJ,et al. Cerebral hemodynamics in relation to patterns of collateral flow[J].Stroke,1999,30(7):1432-1439.
[12]卢洁,李坤成,张苗,等. 64层螺旋CT脑灌注联合CT血管造影在短暂性脑缺血发作的应用[J].中华老年心脑血管病杂志,2006,8(12):806-809.
[13]张亚男,薛静,高培毅,等.单侧烟雾病大脑中动脉供血区血管情况与灌注状态的相关性研究[J].医学影像学杂志,2014,24(10):1669-1673.
[14]王斌,朱凤,周茜萍,等.运用MR血管成像及灌注加权成像评价烟雾病责任血管、术后重建血管及手术前后脑血流动力学变化[J].中华放射学杂志,2014,48(5):381-385.
[15]Dai DW,Zhao WY,Zhang YW,et al. Role of CT perfusion imaging in evaluating the effects of multiple burr hole surgery on adult ischemic Moyamoya disease[J]. Neuroradiology, 2013, 55(12):1431-1438.