多排螺旋CT灌注成像及血管成像對蛛網(wǎng)膜下腔出血后腦血流動力學(xué)改變的臨床研究
發(fā)布時間：2019-05-21 20:08
【摘要】：目的：本研究旨在探討腦血管灌注成像及腦血管造影聯(lián)合診斷對蛛網(wǎng)膜下腔出血后腦血流動力學(xué)改變的臨床診斷及應(yīng)用價值。 方法：收集2010年10月～2013年6月期間經(jīng)牡丹江醫(yī)學(xué)院附屬紅旗醫(yī)院內(nèi)外科收治患者,并篩選經(jīng)臨床診斷符合蛛網(wǎng)膜下腔出血診斷標(biāo)準(zhǔn)及三級以上醫(yī)院出具的相關(guān)影像學(xué)檢查確診為蛛網(wǎng)膜下腔出血病人,經(jīng)CTA檢查排除腦動脈、頸動脈狹窄、閉塞等其他影響因素。選取研究組病例93例,其中男性62例,女性31例,平均年齡為63歲。所有患者均為突發(fā)性意識障礙,突發(fā)或持續(xù)性惡心嘔吐、頭痛、不同程度昏迷、失語、肌力異常、查體頸強(qiáng)直、Kernig征、Brudzinski征等腦膜刺激征。所有入選患者均行64排螺旋CT腦血管造影檢查并分別于3、7、10、14天行腦血管灌注成像檢查。對所有病例經(jīng)靜脈團(tuán)注造影劑后,對已選定層面做連續(xù)動態(tài)采集,并或許相應(yīng)容積數(shù)據(jù)并檢測該層面內(nèi)像素的時間—密度曲線,并將數(shù)據(jù)傳輸至Vitrea23.9工作站,經(jīng)數(shù)據(jù)模型獲取感興趣區(qū)的達(dá)峰時間(time to peak, TTP)、腦血流量(cerebral blood flow,CBF)、腦血容量(cerebral blood volume,CBV)、平均通過時間(mean transit time,MTT)等數(shù)據(jù),通過計算機(jī)數(shù)模轉(zhuǎn)換器及仿真?zhèn)尾始夹g(shù)獲得腦組織灌注功能圖,用以評價病例SAH后局部腦組織血流灌注情況。所有病例CTA掃描容積數(shù)據(jù)傳至Vitrea23.9工作站后經(jīng)兩名主治或副高職醫(yī)師采用雙盲法對數(shù)據(jù)進(jìn)行容積再現(xiàn)(VR)、曲面重建(CPR)、最大密度投影(MIP)重建出大腦動脈環(huán)及其3、4級分支,觀察腦血管形態(tài)變化,并對診斷符合率進(jìn)行復(fù)核診斷。 結(jié)果：本組全部病例均經(jīng)過我院主治或副高職以上醫(yī)師根據(jù)圖像進(jìn)行CTA和CTP分析獲得。本組病例CTA未能顯示腦血管局部痙攣者41例,輕度腦血管痙攣11例,中度腦血管痙攣21例,重度腦血管痙攣20例。于CTA未能顯示腦血管局部痙攣的41例病人中,發(fā)生腦組織局部低灌注者8例(19.5%),其中發(fā)生于腦溝裂殘存血凝塊附近1例,發(fā)生于腦分水嶺區(qū)7例；3例(27.3%)輕度腦血管痙攣患者發(fā)生腦組織低灌注。8例(38.1%)中度腦血管痙攣患者發(fā)生腦組織低灌注。16例(80%)重度腦血管痙攣患者發(fā)生腦組織低灌注。腦血管痙攣程度與腦組織發(fā)生低灌注狀態(tài)成正相關(guān)。 結(jié)論：1.通過CTA掃描下的MIP可客觀反映SAH后患者腦血管走形、分支、及管腔痙攣狹窄程度,通過VR重建可觀察血管管壁及腔內(nèi)情況,并具三維立體的形象效果。對明確患者局部血管管腔狹窄、閉塞情況、確定病變部位和測量狹窄程度作出準(zhǔn)確可靠診斷。2.通過CTP掃描,并針對達(dá)峰時間的分析,可對腦組織血流灌注情況作出最敏感和早期診斷。3.通過多排螺旋CT灌注成像及血管成像聯(lián)合應(yīng)用可對腦組織血流動力學(xué)改變從形態(tài)學(xué)及功能學(xué)多方面綜合作出全面、定量、定性的全面評價。4.通過CTA聯(lián)合CTP檢查對于SAH后腦血流動力學(xué)改變的研究,尋求早期鑒定血管血流動力學(xué)顯著變化的切實有效方法,為臨床醫(yī)生正確診斷、治療機(jī)判斷預(yù)后提供影像學(xué)依據(jù),具有重要的臨床研究意義。
[Abstract]:Objective: The purpose of this study is to investigate the clinical diagnosis and application value of cerebral blood flow dynamic changes after subarachnoid hemorrhage by the combination of cerebrovascular perfusion imaging and cerebral angiography. Methods: During the period from October,2010 to June,2013, the patients were treated with the red flag hospital in Mudanjiang Medical College, and the clinical diagnosis was selected to be in accordance with the diagnosis standard of the subarachnoid hemorrhage and the relevant imaging examination issued by the above three-level hospitals. Human, CTA examination to exclude other effects of cerebral artery, carotid artery stenosis, occlusion, etc. In the study group,93 cases were selected, including 62 males and 31 females, with an average age of 63 Years of age. All patients were of sudden consciousness disorder, sudden or persistent nausea and vomiting, headache, different degree of coma, aphasia, abnormal muscle strength, body neck rigidity, Kernig sign, and Bruzinski's meningeal irritation. Signs: All the enrolled patients underwent a 64-row spiral CT angiography and performed a cerebral perfusion imaging test at 3,7,10 and 14 days, respectively. The time to peak of the region of interest is obtained through the data model, and the time to peak of the region of interest is obtained through the data model. K, TTP, cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and so on. Figure, to evaluate the blood flow perfusion of the local brain after the SAH of the case In all cases, the volume data of CTA in all cases was transferred to Vitrea23.9. The data was reconstructed by double-blind method (VR), surface reconstruction (CPR) and maximum density projection (MIP). The cerebral artery and its 3 and 4 branches were reconstructed by double-blind method. Make a review of the diagnostic accuracy of the diagnosis Results: All the cases of this group were treated by the doctor or the above-mentioned doctors in our hospital according to the image for CTA and CTP. In this group,41 cases of cerebral vasospasm,11 cases of mild cerebral vasospasm,21 cases of moderate cerebral vasospasm and severe cerebral vasospasm were not shown. Of the 41 patients who failed to display the partial cerebral vasospasm,8 (19.5%) of the local hypoperfusion in the brain of the brain, which occurred in 1 case in the vicinity of the residual blood clot in the brain, occurred in the brain watershed. in 7 of that region,3 (27.3%) of the patients with mild cerebral vasospasm had low perfusion in the brain.8 (38.1%) of the patients with moderate cerebral vasospasm had low perfusion in the brain.16 (80%) of the patients with severe cerebral vasospasm had brain tissue Low perfusion. The degree of cerebral vasospasm and the low perfusion state of brain tissue Positive correlation. Conclusion:1. The MIP of the CTA scan can objectively reflect the cerebral blood vessel shape, the branch and the degree of the stenosis of the lumen after the SAH, and the vessel wall and the inside of the cavity can be observed through the reconstruction of VR, and the three-dimensional three-dimensional model can be used. The effect of the image on the stenosis and the occlusion of the local vascular lumen of a clear patient, the determination of the position of the lesion and the degree of the measurement of the stenosis can be accurately by the diagnosis.2. By means of the CTP scan, and for the analysis of the peak time, it is possible to make the most sensitive and early to the blood flow perfusion in the brain tissue 3. Through the combined application of multi-slice spiral CT perfusion imaging and blood vessel imaging, the changes of hemodynamics in brain tissue can be comprehensively, quantitatively and qualitatively analyzed from the aspects of morphology and function. 4. According to the study of the changes of cerebral blood flow dynamics after SAH by the combination of CTA and CTP, an effective and effective method for early identification of the changes in the blood flow dynamics of the blood vessel was sought.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.35
本文編號：2482358
[Abstract]:Objective: The purpose of this study is to investigate the clinical diagnosis and application value of cerebral blood flow dynamic changes after subarachnoid hemorrhage by the combination of cerebrovascular perfusion imaging and cerebral angiography. Methods: During the period from October,2010 to June,2013, the patients were treated with the red flag hospital in Mudanjiang Medical College, and the clinical diagnosis was selected to be in accordance with the diagnosis standard of the subarachnoid hemorrhage and the relevant imaging examination issued by the above three-level hospitals. Human, CTA examination to exclude other effects of cerebral artery, carotid artery stenosis, occlusion, etc. In the study group,93 cases were selected, including 62 males and 31 females, with an average age of 63 Years of age. All patients were of sudden consciousness disorder, sudden or persistent nausea and vomiting, headache, different degree of coma, aphasia, abnormal muscle strength, body neck rigidity, Kernig sign, and Bruzinski's meningeal irritation. Signs: All the enrolled patients underwent a 64-row spiral CT angiography and performed a cerebral perfusion imaging test at 3,7,10 and 14 days, respectively. The time to peak of the region of interest is obtained through the data model, and the time to peak of the region of interest is obtained through the data model. K, TTP, cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and so on. Figure, to evaluate the blood flow perfusion of the local brain after the SAH of the case In all cases, the volume data of CTA in all cases was transferred to Vitrea23.9. The data was reconstructed by double-blind method (VR), surface reconstruction (CPR) and maximum density projection (MIP). The cerebral artery and its 3 and 4 branches were reconstructed by double-blind method. Make a review of the diagnostic accuracy of the diagnosis Results: All the cases of this group were treated by the doctor or the above-mentioned doctors in our hospital according to the image for CTA and CTP. In this group,41 cases of cerebral vasospasm,11 cases of mild cerebral vasospasm,21 cases of moderate cerebral vasospasm and severe cerebral vasospasm were not shown. Of the 41 patients who failed to display the partial cerebral vasospasm,8 (19.5%) of the local hypoperfusion in the brain of the brain, which occurred in 1 case in the vicinity of the residual blood clot in the brain, occurred in the brain watershed. in 7 of that region,3 (27.3%) of the patients with mild cerebral vasospasm had low perfusion in the brain.8 (38.1%) of the patients with moderate cerebral vasospasm had low perfusion in the brain.16 (80%) of the patients with severe cerebral vasospasm had brain tissue Low perfusion. The degree of cerebral vasospasm and the low perfusion state of brain tissue Positive correlation. Conclusion:1. The MIP of the CTA scan can objectively reflect the cerebral blood vessel shape, the branch and the degree of the stenosis of the lumen after the SAH, and the vessel wall and the inside of the cavity can be observed through the reconstruction of VR, and the three-dimensional three-dimensional model can be used. The effect of the image on the stenosis and the occlusion of the local vascular lumen of a clear patient, the determination of the position of the lesion and the degree of the measurement of the stenosis can be accurately by the diagnosis.2. By means of the CTP scan, and for the analysis of the peak time, it is possible to make the most sensitive and early to the blood flow perfusion in the brain tissue 3. Through the combined application of multi-slice spiral CT perfusion imaging and blood vessel imaging, the changes of hemodynamics in brain tissue can be comprehensively, quantitatively and qualitatively analyzed from the aspects of morphology and function. 4. According to the study of the changes of cerebral blood flow dynamics after SAH by the combination of CTA and CTP, an effective and effective method for early identification of the changes in the blood flow dynamics of the blood vessel was sought.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.35
【參考文獻(xiàn)】
相關(guān)期刊論文 前9條
1 李響;李松柏;李春志;卑貴光;蔣寶國;;蛛網(wǎng)膜下腔出血的CT灌注成像研究[J];中國臨床醫(yī)學(xué)影像雜志;2010年03期
2 張峰;劉建峰;李鵬;井山泉;張超;;動脈瘤性蛛網(wǎng)膜下腔出血后癥狀性腦血管痙攣的相關(guān)因素研究進(jìn)展[J];中國全科醫(yī)學(xué);2012年21期
3 劉偉國;楊小鋒;曹飛;鄭秀玨;沈宏;傅偉明;呂世亭;;動脈瘤性蛛網(wǎng)膜下腔出血后癥狀性血管痙攣186例[J];中華醫(yī)學(xué)雜志;2006年15期
4 代垠;焦松;任光陽;王玉玉;李剛;李毅;肖順武;張學(xué)軍;猶春躍;吳海濤;;血管壁ICAM-1和細(xì)胞凋亡在大鼠腦血管痙攣中作用的實驗研究[J];遵義醫(yī)學(xué)院學(xué)報;2011年06期
5 任傳成,王云甫,謝連紅,周亞剛,錢湘綺,余桂軍,周玲,倪冬艷;GM1對腦血管痙攣后神經(jīng)元及血管內(nèi)皮細(xì)胞的影響[J];卒中與神經(jīng)疾病;2005年01期
6 曹貴方;楊春祥;汪慧;孫陽;夏一魯;;他汀類藥物預(yù)防蛛網(wǎng)膜下腔出血患者遲發(fā)性腦血管痙攣療效的薈萃分析[J];卒中與神經(jīng)疾病;2008年02期
7 范議方;韓如泉;;大鼠兩種腦血管痙攣模型的早期腦損傷研究[J];卒中與神經(jīng)疾病;2010年06期
8 葛起雪;武炎;王春玲;王少杰;;針刺加靜脈滴注川芎嗪治療椎—基底動脈供血不足46例臨床觀察[J];中醫(yī)雜志;2007年05期
9 葛辛;葛們;彭玉清;陳云翔;;中藥對33例動脈硬化性閉塞癥患者甲襞微循環(huán)和肢體血流速度的影響[J];中醫(yī)雜志;2002年04期
，本文編號：2482358
本文鏈接：http://sikaile.net/yixuelunwen/shenjingyixue/2482358.html
最近更新
教材專著
