摘要
目的:探讨CT灌注成像(CT perfusion,CTP)预测蛛网膜下腔出血(subarachnoid hemorrhage,SAH)后迟发性脑缺血(delayed cerebral ischemia,DCI)的临床价值。方法:回顾性分析122例SAH患者临床资料,记录CTP相关参数,包括脑血流量(cerebral blood flow,CBF)、脑血容量(cerebral blood volume,CBV)、平均通过时间(mean transit time,MTT)及达峰时间(time to peak,TTP)。根据病程中有无DCI,将研究对象分为DCI组和Non-DCI组,比较两组间CTP参数的差异,使用ROC曲线评价各参数对DCI早期预测的价值。结果:122例患者中,发生DCI 43例,未发生DCI 79例。DCI组的CBF值低于Non-DCI组,MTT、TTP较后者延长,双侧灌注差异更为显著(P<0.05)。CBF、CBV、CBF比值、CBV比值、MTT、TTP、MTT差值、TTP差值的ROC曲线下面积分别为:0.87、0.69、0.81、0.76、0.88、0.72、0.71、0.78;预测DCI最佳诊断界值分别为:15.91 ml/(min·ml)、1.76 ml/100 g、0.84、0.83、9.65、11.46、0.68、0.48 s。MTT、CBF、CBF比值预测DCI价值较高,其敏感度和特异度分别为:69.77%和93.67%、72.10%和88.60%、69.77%和91.14%。结论:SAH后脑微循环的状态能通过CTP检查来评估,CTP检查在早期预测DCI的发生具有一定的可靠性。
Objective：To observe the diagnostic threshold values of predicting delayed cerebral ischemia（DCI）after subarachnoid hemorrhage（SAH）with computed tomography perfusion（CTP）. Methods：Totally 122 patients with SAH were respectively enrolled.CT perfusion values,including cerebral blood flow（CBF）,cerebral blood volume（CBV）,mean transit time（MTT）,and time to peak（TTP）in predefined regions of interest were measured. All patients were divided into DCI group and non-DCI group. Diagnostic threshold values for DCI were evaluated and sensitivity and specificity were calculated for optimal thresholds. Results：Of 122 patients with SAH,43 had DCI,79 didn＇t have DCI. The CBF was lower,MTT and TTP was longer and perfusion asymmetry was lager in DCI group than in non-DCI group（P〈0.05）. The areas under ROC curves of CBF,CBV,CBF ratio,CBV ratio,MTT,TTP,MTT difference,TTP difference were 0.87,0.69,0.81,0.76,0.88,0.72,0.71,0.78;the optimal threshold values were 15.91ml/（min·ml）,1.76 ml/100 g,0.84,0.83,9.65,11.46,0.68,0.48 s. MTT,CBF,CBF ratio had high diagnostic value in predicting DCI and the sensitivity and specificity were MTT of 69.77% and 93.67%,CBF of 72.10% and 88.60% and CBF of 69.77% and 91.14%. Conclusion：The cerebral microcirculation hemodynamic after SAH can be evaluated by CTP. CT perfusion is an early and reliable predictor of DCI.
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2016年第8期850-854,共5页
Journal of Chongqing Medical University
基金
国家临床重点专科建设经费资助项目(编号:社财{2011}170号)
关键词
蛛网膜下腔出血
CT灌注成像
迟发性脑缺血
脑微循环
subarachnoid hemorrhage
CT perfusion
delayed cerebral ischemia
cerebral microcirculation
