DSCTA联合早期疗效的评价CTPI对颅内外动脉吻合术后

目的联合应用数字减影CT血管造影(DSCTA)和CT灌注成像(CTPI)对颅内外动脉吻合术(EIAB)后早期疗效进行评价。方法因脑血管疾病经受了EIAB的患者18例,其中9例行术后DSCTA检查,13例行手术前后CTPI检查,其中4例同时接受手术前后CTPI检查和术后DSCTA检查。结果 CTPI显示8例术后脑血供明显改善,表现为原异常灌注区域范围减小,部分吻合血管周围脑组织呈过度灌注状态,脑血容量、脑血流量明显增加,平均通过时间明显缩短(P0.05);3例术后脑血供无明显变化;2例脑血供减少。术后DSCTA显示搭桥血管通畅7条,闭塞3条。DSCTA可清楚显示旁路血管全程及吻合口的部位、大小或宽度。多平面重组(MPR)和去骨结构容积再现重建均可清楚显示搭桥血管及吻合口,但MRP更有助于测量吻合口的宽度。结论联合应用DSCTA和CTPI成像技术可对EIAB后早期疗效进行无创性定量评估,具有良好的临床应用前景。

Application of digital subtraction CT angiography and CT perfusion imaging to assessment of curative effect of extracranial-intracranial arterial bypass on some cerebrovascular diseases

Objective To explore value of digital subtraction CT angiography （DSCTA） and CT perfusion imaging （CTPI） to assessment of the curative effects of the extracranial-intracranial arterial bypass （EIAB） on some cerebrovascular diseases.Methods EIAB surgery was performed in 18 patients,of whom,14 suffered from Moyamoya disease,2 huge intracranial aneurysms,1 internal carotid artery aneurysm accompanied with cerebral infarction and 1 occlusion of middle cerebral artery after the surgery for anterior communicating artery aneurysm.DSCTA was performed after EIAB in 9 patients and CTPI was performed before and after EIAB in 13 patients,in whom,4 still received DSCTA examinations after EIAB.Results There was abnormal cerebral perfusion before EIAB in 13 patients.The blood supply to the brain was significantly improved after EIAB surgery in 8 patients compared to before the EIAB.The improvement of the blood supply to the brain included the decrease in the cerebral hypoperfusion area,hyperperfusion in some cerebral regions around the bypass,increase in cerebral blood volume and cerebral blood flow and shortened mean transmitting time.There was no remarkable change in the blood supply to the brain after EIAB in 3 patients.The blood supply to the brain decrease after EIAB in 2 patients.The postoperative DSCTA showed that 7 anastomosed vessels were clear and 3 were occluded after the surgery.The anastomosed vessels and the site,size or width of anastomosis mouth could be well shown by DSCTA.The anastomosed arteries and the anastomosis mouths could be shown well by multiplane recombination （MPR） and bone removal volume rendering reconstruction.MRP was more helpful to measuring the width of anastomosis mouth.Conclusion DSCTA combined with CTPI can noninvasively assess the early curative effect of EIAB on the some cerebrovascular disease and it may be clinically applied.