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目的 CT灌注成像技术对颅内动脉瘤破裂蛛网膜下腔出血(SAH)所产生的脑血管痉挛(CVS)的诊断价值。方法 30例动脉瘤破裂SAH患者均在出血后急诊DSA造影和血管内栓塞治疗。分别于出血后3、7、10、142、1d行CT灌注成像(CTPI)检查。选择6例正常志愿者的脑CTPI数据作为对照。结果 30例患者中,10例出现脑缺血症状。与对照组比较,无脑缺血症状组脑血流量(CBF)值出血后第14天明显降低,造影剂平均通过时间(MTT)值于出血后第10、14天明显延长(P<0.05)。脑缺血症状组MTT值第7天开始即升高,且至21 d仍然高于对照组(P<0.05)。感兴趣区CBF值第10天开始降低,持续至第14天,脑血容量(CBV)值第14天起开始降低,至21 d数值仍低于对照组(P<0.05)。结论 MTT是判断迟发性脑血管痉挛比较敏感的指标。CBF对于检测脑组织异常灌注具有较高的敏感性和稳定性。CBV显著下降是预测不可逆性脑梗死的较为准确的指标。
Objective To evaluate the value of CT perfusion imaging in the diagnosis of cerebral vasospasm (CVS) caused by ruptured subarachnoid hemorrhage (SAH) in intracranial aneurysms. Methods Thirty patients with aneurysm ruptured SAH underwent emergency DSA angiography and endovascular embolization after hemorrhage. The CT perfusion imaging (CTPI) was performed on the 3, 7, 10, 142 and 1 d after hemorrhage respectively. Brain CTPI data from 6 normal volunteers were selected as controls. Results Among 30 patients, 10 cases had cerebral ischemia symptoms. Compared with the control group, CBF decreased significantly on the 14th day after cerebral hemorrhage, mean MTT increased significantly on the 10th and 14th day after hemorrhage (P <0.05) . The MTT value of cerebral ischemic symptom group increased from the 7th day to the 21st day and still higher than that of the control group (P <0.05). The region of interest (CBF) began to decrease from the 10th day to the 14th day, and the CBV began to decrease from the 14th day to the 21st day (P <0.05). Conclusion MTT is a more sensitive indicator of delayed cerebral vasospasm. CBF has high sensitivity and stability for detecting abnormal perfusion of brain tissue. A significant decrease in CBV is a more accurate predictor of irreversible cerebral infarction.