本文選題：煙霧病 + CT灌注成像�。� 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討CT灌注成像(CTP)在煙霧病聯(lián)合血管重建術(shù)治療中的應(yīng)用價值。方法:回顧性分析8例我科近1年收治的,均經(jīng)全腦血管造影術(shù)(DSA)檢查確診為煙霧病的患者的病例資料。所有患者均行顳淺動脈-大腦中動脈分支吻合術(shù)+腦-硬腦膜-肌肉血管融合術(shù)(STA-MCA anastomosis combined with encepho-duro-myo-synangiosis,STA-MCA+EDMS)治療,分別于術(shù)前、術(shù)后2周行頭顱CTP檢查。使用飛利浦256層螺旋CT,選取并設(shè)定管電壓為120KV、管電流150mAs的顱腦灌注掃描模式,同時設(shè)定掃描層厚及覆蓋范圍分別為5mm及12×12cm,單次掃描時間50s。使用碘普羅胺(370mgI/ml)為顱腦成像的對比顯影劑,用高壓注射器以5ml/s的速率將對比劑經(jīng)肘靜脈注入人體,使用總劑量為50ml。首次掃描可獲得300-400幅原始圖像,將該原始圖像傳入到后期處理設(shè)備,選用腦灌注軟件進行分析處理,選取基底動脈及上矢狀竇確定動脈輸入函數(shù)及靜脈輸出函數(shù),應(yīng)用去卷積數(shù)學(xué)模型獲得腦血流量(CBF)、腦血容量(CBV)、平均通過時間(MTT)和達峰時間(TTP)的灌注參數(shù)圖像。認真觀察偽彩圖中顯示的腦組織缺血部位,并在缺血灶最廣的層面勾畫出感興趣的異常灌注區(qū)。以鏡像方法測量兩側(cè)的CBF、CBV、MTT和TTP值,以手術(shù)側(cè)參數(shù)值比對側(cè)參數(shù)值,獲得相對CBF(rCBF)、相對CBV(rCBV)、相對MTT(rMTT)和相對TTP(rTTP)。所得數(shù)據(jù)的整理和分析全部使用SPSS19.0統(tǒng)計學(xué)軟件,將術(shù)前和術(shù)后2周對應(yīng)供血區(qū)域的rCBV、rCBF、rMTT、rTTP值進行配對t檢驗,P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:8例行STA-MCA+EDMS聯(lián)合術(shù)式治療的煙霧病患者,手術(shù)前術(shù)側(cè)呈現(xiàn)不同程度低灌注,且相比對側(cè)明顯;手術(shù)治療后術(shù)側(cè)腦血流灌注得到改善,表現(xiàn)為rCBF、rCBV均較術(shù)前增加,rMTT較術(shù)前縮短,差異有統(tǒng)計學(xué)意義(P＜0.05)。手術(shù)前后rTTP的改變差異無統(tǒng)計學(xué)意義(P0.05)。術(shù)后CTA顯示搭橋血管無狹窄、閉塞,血流通暢。結(jié)論:CT灌注成像能精確顯示煙霧病患者腦組織缺血的范圍及程度,為術(shù)者準(zhǔn)確了解病情、選擇手術(shù)適應(yīng)癥及手術(shù)方式提供客觀依據(jù);CT灌注成像對評估煙霧病聯(lián)合血管重建術(shù)患者術(shù)后腦組織血流灌注的改善及預(yù)后有重要意義。
[Abstract]:Objective: to evaluate the value of CT perfusion imaging (CTP) in the treatment of moyamoya disease combined with revascularization. Methods: the data of 8 cases of moyamoya disease diagnosed by whole cerebrovascular angiography (DSA) were retrospectively analyzed. All patients were treated with STA-MCA anastomosis combined with encepho-duro-myo-synangiosis-STA-MCA EDMS before and 2 weeks after operation. Using Philips 256-layer spiral CTs, the scanning mode of brain perfusion was selected and set the voltage of the tube was 120kV and the current of the tube was 150mAs. The thickness and coverage of the scanning layer were 5mm and 12 脳 12cm, respectively, and the scanning time was 50s. Iopramide 370mg I / ml was used as contrast medium for craniocerebral imaging. The contrast agent was injected into human body through elbow vein with high pressure syringe at the rate of 5ml/s. The total dose was 50ml. 300-400 original images were obtained from the first scan. The original images were transferred to the post-processing equipment. The cerebral perfusion software was used to analyze and process, and the basilar artery and the superior sagittal sinus were selected to determine the arterial input function and the venous output function. The perfusion parameters of CBF, CBV, MTT and TTPwere obtained by using deconvolution mathematical model. The ischemic regions of brain tissue were observed carefully and the abnormal perfusion areas of interest were drawn on the widest level of ischemic foci. The MTT and TTP values of CBFV were measured by the mirror image method. The relative CBF rCBF, the relative CBV rCBV, the relative MTTr MTT and the relative TTPr TTP were obtained by comparing the operation side parameters with the side parameters. The data were collected and analyzed by SPSS 19.0 statistical software. The rCBVV rCBFU rMTTT rTTP value corresponding to the blood supply area was compared with the matched t test (P0.05) before and 2 weeks after operation. Results in 8 patients with moyamoya disease treated with STA-MCA EDMS combined operation, there were different degrees of hypoperfusion and significant difference between the two sides before operation, and the cerebral blood flow perfusion was improved after operation, which showed that the increase of rCBF rCBV was shorter than that before operation, and the increase of rCBFU rCBV was shorter than that before operation. The difference was statistically significant (P < 0.05). There was no significant difference in rTTP before and after operation (P 0.05). CTA showed no stenosis, occlusion and smooth blood flow. Conclusion Perfusion imaging with 10% CT can accurately show the extent and extent of cerebral ischemia in patients with moyamoya disease. The selection of operative indications and surgical methods provides objective basis for CT perfusion imaging to evaluate the improvement and prognosis of cerebral blood flow perfusion in patients with moyamoya disease combined with revascularization.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3
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本文編號：1992280