摘要
目的利用4D-CTA联合全脑灌注成像的方法评估颅内动脉瘤术后血管及血流动力学改变。方法回顾性分析49例颅内动脉瘤性蛛网膜下腔出血（SAH）术后的患者,所有患者均于发生SAH 3~14天内行全脑灌注成像检查。使用西门子公司Syngo MMWP后处理工作站,用Inspace软件重组4D-CTA图像,以VPCT Neuro软件,生成脑血流量（CBF）、血容量（CBV）、达峰时间（TTP）、延迟时间（TTD）及平均通过时间（MTT）伪彩图。在检查残余动脉瘤的同时判断有无脑血管痉挛及其他血管病变,并用灌注参数评估SAH继发的迟发性脑缺血情况及其他并发症。结果 4D-CTA共检出59个颅内动脉瘤的术后改变。其中动脉瘤夹闭术后50个,栓塞术后9个。1例前交通动脉瘤夹闭术后存在残留动脉瘤。2例患者发现颅内其他部位存在动脉瘤。4D-CTA上18例患者共28条血管出现血管痉挛。共29例患者的伪彩图上出现异常灌注区域,其中23例患者为迟发性缺血,2例患者为血管夹压迫相关脑缺血,4例患者为手术操作损伤相关脑缺血。结论 4D-CTA可清晰显示动脉瘤术后有无瘤体残留、动脉瘤夹及栓塞材料与载瘤血管的关系。4D-CTA联合全脑灌注成像可同时显示宏观上的血管痉挛及灌注上的微循环改变。全脑灌注成像可显示术后多种并发症所导致的血流动力学改变。
Objective To discuss the feasibility,reliability and advantages of 4D-CTA combined with whole brain CT perfusion imaging in evaluating hemodynamic changes of cerebral aneurysms after operation.Methods The clinical data and imaging materials of 49 patients with subarachnoid hemorrhage（ SHA） due to cerebral aneurysm,who had received surgery,were retrospective analyzed.4D-CTA together with whole brain CT perfusion imaging was performed in all patients within 3- 14 days after the onset of SAH.Inspace software was used to reconstruct the 4D-CTA images on a Siemens Syngo MMWP post-processing workstation; by using VPCT Neuro software the cerebral blood flow（ CBF）,cerebral blood volume（ CBV）,time-to-peak（ TTP）,time-to-drain（ TTD） and mean transit time（ MTT） on pseudo-color image were measured.The residual aneurysm was examined,and at the same time the presence or absence of cerebral vasospasm and other vascular lesions was judged.Perfusion parameters were used to evaluate the secondary delayed cerebral ischemia and other complications.Results A total of 59 aneurysmal postoperative changes,including aneurysm clipping（ n = 50） and embolization（ n = 9）,were detected by 4D-CTA.Aneurysm remnant was found in one case who had anterior communicating aneurysm after surgical clipping.In two patients additional aneurysms at other location were observed.A total of 28 vasospasm vessels were observed in 18 patients.Abnormal perfusion areas were demonstrated on pseudo-color images in 29 patients,including delayed cerebral ischemia（ n = 23）,cerebral ischemia caused by vascular clip compression（ n = 2） and cerebral ischemia due to surgical injury（ n = 4）.Conclusion 4D-CTA can clearly show the residue of aneurysm and display the relationship between the aneurysm clips or embolization materials and the parent vessel.4D-CTA combined with whole brain CT perfusion imaging can reveal postoperative hemodynamic changes caused by a variety of complications.
出处
《临床放射学杂志》
CSCD
北大核心
2015年第3期332-336,共5页
Journal of Clinical Radiology
关键词
CTA
全脑灌注成像
颅内动脉瘤
血管痉挛
CT angiography Whole brain CT perfusion imaging intracranial aneurys Vasospasm
