本文關(guān)鍵詞： 頸內(nèi)動(dòng)脈狹窄 血流動(dòng)力學(xué) 支架植入 DSA 參數(shù)成像　出處：《廣西醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：用DSA參數(shù)成像評(píng)價(jià)頸內(nèi)動(dòng)脈狹窄患者CAS前后腦血流動(dòng)力學(xué)的變化，為臨床開展CAS提供參考數(shù)據(jù)。 方法：收集一側(cè)頸內(nèi)動(dòng)脈重度狹窄患者，經(jīng)DSA確診且患者及家屬同意行CAS治療33例，其中男性19例，女性14例，年齡52～75歲，平均年齡64.5±6.4歲。CAS前以頸內(nèi)動(dòng)脈狹窄處為中心行正側(cè)位片全腦血管造影，記錄心率和血壓值，記錄有無(wú)血管痙攣，CAS后以同樣方法造影，保持導(dǎo)管位置、大小、DSA設(shè)備相關(guān)參數(shù)與CAS前一致。 圖像分析用截圖軟件和Photoshop圖像處理軟件相結(jié)合對(duì)圖像進(jìn)行分析處理，分別選擇頸內(nèi)動(dòng)脈末端、腦組織及靜脈竇的上矢狀竇區(qū)為感興趣區(qū)，獲得各感興趣區(qū)的密度值。利用Excel軟件分別求得各感興趣區(qū)的時(shí)間—密度（灰度）曲線，，從各曲線中提取峰值、達(dá)峰時(shí)間、峰值出現(xiàn)時(shí)間、平均通過(guò)時(shí)間、腦循環(huán)時(shí)間等參數(shù)，進(jìn)行分析研究。 結(jié)果：1.CAS前后動(dòng)脈狹窄側(cè)顱內(nèi)血管顯影情況 狹窄側(cè)有2例術(shù)前造影未見大腦前動(dòng)脈顯影，術(shù)后即刻造影大腦前動(dòng)脈顯影清楚；1例術(shù)前造影大腦中動(dòng)脈遠(yuǎn)端顯影淺淡，術(shù)后顯影清楚。 2.CAS前后腦組織DSA影像變化 術(shù)后腦組織DSA影像示染色加深，表現(xiàn)在同一術(shù)前動(dòng)脈期觀察點(diǎn)觀察術(shù)后血管造影，有更多的小動(dòng)脈和毛細(xì)血管顯影或有小靜脈、靜脈以及靜脈竇顯影。33例患者中有19例表現(xiàn)小動(dòng)脈和毛細(xì)血管顯影增多，5例靜脈顯影，3例靜脈竇顯影，6例影像未見明顯變化。 3.CAS前后DSA參數(shù)變化 頸內(nèi)動(dòng)脈ROI區(qū)峰值術(shù)后大于術(shù)前，達(dá)峰時(shí)間術(shù)后小于術(shù)前，峰值出現(xiàn)時(shí)間術(shù)前后差別無(wú)統(tǒng)計(jì)學(xué)意義。 腦組織ROI區(qū)峰值術(shù)后大于術(shù)前，達(dá)峰時(shí)間、峰值出現(xiàn)時(shí)間、平均通過(guò)時(shí)間術(shù)后小于術(shù)前。 靜脈竇ROI區(qū)峰值術(shù)后大于術(shù)前，達(dá)峰時(shí)間、峰值出現(xiàn)時(shí)間術(shù)后小于術(shù)前。 腦循環(huán)時(shí)間術(shù)后小于術(shù)前，即從術(shù)前的（2.41±0.57）s下降至術(shù)后的（1.92±0.56）s。 4.CAS后各參數(shù)指標(biāo)改善情況 33例患者術(shù)后頸內(nèi)動(dòng)脈、腦組織、上矢狀竇感興趣區(qū)PV值分別增加了7.43±3.64、1.89±1.26、6.72±9.70，TP值分別縮短了（0.61±0.30）s、（0.64±0.42）s、（0.45±0.64）s；腦組織、上矢狀竇感興趣區(qū)TAPV值分別縮短了(0.53±0.56)s、(0.59±0.86)s，MTT值分別縮短（1.08±0.81）s、（0.95±0.82）s；腦循環(huán)時(shí)間縮短了（0.48±0.73）s。 結(jié)論：DSA參數(shù)成像技術(shù)可檢測(cè)CAS前后腦灌注和腦血流動(dòng)力學(xué)的變化，峰值、腦組織平均通過(guò)時(shí)間和腦循環(huán)時(shí)間更為敏感。
[Abstract]:Objective: to evaluate the changes of cerebral hemodynamics in patients with internal carotid artery stenosis before and after CAS by DSA parameter imaging, and to provide reference data for clinical development of CAS. Methods: a total of 33 patients with severe stenosis of the internal carotid artery were treated with CAS, including 19 males and 14 females aged 52 to 75 years, who were diagnosed by DSA and agreed to be treated with CAS. The mean age was 64.5 鹵6.4 years. Before CAS, the anterior and lateral radiographic angiography was performed on the stenosis of the internal carotid artery. The heart rate and blood pressure were recorded, and the vasospasm was recorded. The relative parameters of CAS equipment were the same as those before CAS. Image analysis was performed with the combination of capture software and Photoshop image processing software. The end of internal carotid artery and the area of superior sagittal sinus of cerebral tissue and venous sinus were selected as the areas of interest respectively. The time-density curve of each region of interest was obtained by Excel software, and the parameters such as peak value, peak time, peak time, mean transit time, cerebral circulation time were extracted from each curve. Carry on the analysis research. Results 1. Development of intracranial vessels in the stenosis side of the artery before and after CAS. In the stenotic side, the anterior cerebral artery was not developed in 2 cases before operation, the anterior cerebral artery was clearly developed immediately after operation, and the distal part of the middle cerebral artery in 1 case was superficial, and the development was clear after operation. 2. DSA imaging changes of brain tissue before and after CAS. The DSA images of brain tissue showed that the staining deepened after operation, which was observed at the observation point of the same preoperative arterial phase, and there were more arterioles and capillaries developed or venules. Among the 33 cases of venous and venous sinus imaging, 19 cases showed increased arterioles and capillaries in 5 cases, venous angiography in 3 cases and venous sinus imaging in 6 cases, and no obvious changes were found in 6 cases. 3. Changes of DSA parameters before and after CAS. The peak value of ROI in internal carotid artery after operation was larger than that before operation, and the time to peak after operation was less than that before and after operation, and there was no significant difference before and after the operation. The peak value of ROI in brain tissue after operation was longer than that before operation, the peak time and the time of peak value appeared, and the mean transit time was less than that before operation. The peak value of ROI in venous sinus was longer than that before operation, and the peak time was lower than that before operation. The time of cerebral circulation decreased from 2.41 鹵0.57 s to 1.92 鹵0.56 s after operation. 4. Improvement of parameters after CAS. After operation, the PV values of internal carotid artery, brain tissue and superior sagittal sinus were increased by 7.43 鹵3.64t 1.89 鹵1.266.72 鹵9.70m TP, 0.61 鹵0.30mSU 0.64 鹵0.42sm 0.45 鹵0.64s, TAPV values of brain tissue and superior sagittal sinus area of interest were shortened by 0.53 鹵0.56s, 0.59 鹵0.86sm and 1.08 鹵0.81s / 0.95 鹵0.82s, respectively, respectively, and the cerebral circulation time was shortened by 0.48 鹵0.73s / s, respectivelyly, the TAPV value of the area of interest to the superior sagittal sinus was shortened by 0.53 鹵0.56 ~ 0.56 ~ (?) ~ (?) ~ 0.59 鹵0.86 ~ (-1)??? Conclusion the changes of cerebral perfusion and cerebral hemodynamics before and after CAS can be detected by Mr DSA parameter imaging. The peak value, the average transit time of brain tissue and the time of cerebral circulation are more sensitive.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743

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