幕上分水岭脑灌注与ICA狭窄程度的相关性研究
裴禹淞 乔鑫鑫 王治国 张国旭
中国人民解放军北部战区总医院，辽宁 沈阳 110016
通信作者：张国旭
【摘要】 目的 应用 CT 灌注（computed tomography perfusion，CTP）成像技术探讨幕上各分水岭区血流灌注与颈内动脉（internal carotid artery，ICA）狭窄程度的相关性。方法 分析 97 例单侧 ICA 狭窄（≥50%）患者的临床及 CTP 资料，并以 37 例无血管狭窄（或单侧 ICA 狭窄<50%）患者为对照组。所有患者在入院后均行 CT 平扫、CTP 及数字减影血管造影（digital subtraction angiography，DSA）检查，对称性选取双侧幕上各分水岭区，进行参数值的测量。分析不同狭窄程度组各分水岭区的灌注状态。结果 单侧ICA 狭窄时，各个分水岭区患侧与健侧的平均通过时间（mean transit time，MTT）和达峰时间 （time to peak，TTP）差异有统计学意义（P<0.05），患侧较健侧时间延长；仅在半卵圆中心患侧脑血流量（cerebral blood flow，CBF）较健侧明显降低，差异有统计学意义（P<0.05）；后角白质患侧脑血容量（cerebral blood volume，CBV）较健侧增加，差异有统计学意义（P<0.05）；前角和后角的灰质 CBF、CBV 均高于同侧白质，差异有统计学意义（P<0.05）。半卵圆中心 rCBF、rTTP、rMTT 在不同狭窄组间差异有统计学意义（P<0.05），放射冠 rTTP、rMTT 在不同狭窄组间差异有统计学意义（P<0.05），前角白质 rTTP 在不同狭窄组间差异有统计学意义（P<0.05）。结论 CTP 成像能够有效评价幕上分水岭区脑血流灌注情况。单侧 ICA 狭窄时，不同分水岭区脑血流灌注存在差异；单侧 ICA 重度狭窄或闭塞时，仅半卵圆中心表现为低灌注。
【关键词】 颈内动脉；狭窄；分水岭；CT 灌注
【中图分类号】 R445.3 【文献标识码】 A 【文章编号】 1673-5110 （2022） 06-0705-08
基金项目：辽宁省重点研发资助计划（编号：2019JH2/10300010）
DOI：10.12083/SYSJ.220559
Study on the correlation between brain watershed perfusion and ICA Stenosis
PEI Yusong，QIAO Xinxin，WANG Zhiguo，ZHANG Guoxu
General Hospital of Northern Theater Command，Shenyang 110016，China
Corresponding author：ZHANG Guoxu
【Abstract】 Objective The correlation between blood perfusion in the supratentorial watersheds and the degree of stenosis of the internal carotid artery（ICA）was investigated by computed tomography perfusion（CTP） imaging technology. Methods 97 patients with unilateral ICA stenosis（≥50%）were analyzed，and 37 patients without vascular stenosis（or unilateral ICA stenosis <50%）were used as the control group. All patients underwent CT scan，CTP and digital subtraction angiography（DSA）examination after admission. The watershed areas of the bilateral supratentorial areas were selected symmetrically to measure the parameter values. The perfusion status of each watershed area in different stenosis degree groups was statistically analyzed. Result In the case of unilateral ICA stenosis，the difference in mean transit time（MTT）and time to peak（TTP）between the affected side and the healthy side in each watershed area was statistically significant（P<0.05），and the affected side was more healthy than the healthy side. Only the cerebral blood flow（CBF）on the affected side of the semiovale center was significantly lower than that on the healthy side，and the difference was statistically significant （P<0.05），CBV）was increased compared with the healthy side，and the difference was statistically significant（P<0.05）. The rCBF，rTTP and rMTT in the center of semiovale were statistically significant between different stenosis groups（P<0.05），the corona radiata rTTP and rMTT were statistically significant between different stenosis groups（P<0.05），and the anterior horn white matter rTTP in different stenosis groups There was statistical significance（P<0.05）. Conclusion CTP imaging can effectively evaluate the cerebral blood perfusion in the supratentorial watershed area. In unilateral ICA stenosis，there were differences in cerebral blood perfusion in different watershed areas；in severe unilateral ICA stenosis or occlusion，only the center of semiovale showed hypoperfusion.
【Key words】 Internal carotid artery；Stenosis；CT perfusion imaging；watershed
