摘要
目的探讨四维CT血管造影(4D CTA)-CT灌注(CTP)成像评价烟雾病及烟雾综合征患者侧支循环分级的价值及其与脑血流动力学的关系。方法回顾性分析2017年1月至2022年1月北京医院确诊为烟雾病及烟雾综合征的32例患者临床及影像资料。所有患者均接受4D CTA-CTP检查。在4D CTA图像上采用Alberta卒中项目早期CT评分, 在数字减影血管造影(DSA)图像上采用美国介入和治疗神经放射学学会/介入放射学学会侧支循环改良评分系统对患者侧支循环情况进行评分并将其分为侧支代偿Ⅰ~Ⅲ级。在CTP图像上选择基底核层面勾画兴趣区并测量各灌注参数, 包括脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)、达峰时间(TTP)、延迟时间(DLY)。采用Kruskal-Wallis检验比较不同侧支循环分级各灌注参数的差异, 两两比较以Bonferroni校正。采用Kappa及Spearman检验分析4D CTA和DSA对侧支循环分级的一致性和相关性。结果 4D CTA与DSA评估患者侧支循环分级的一致性中等(Kappa=0.693, P<0.001)且相关性极强(r=0.805, P<0.001)。侧支代偿Ⅰ级、侧支代偿Ⅱ级、侧支代偿Ⅲ级的CBF、MTT、TTP差异均有统计学意义(H值分别为7.91、11.69、8.93, P值分别为0.019、0.003、0.012)。进一步两两比较显示, 侧支代偿Ⅰ级的CBF低于侧支代偿Ⅲ级(P=0.015), 侧支代偿Ⅱ级MTT高于侧支代偿Ⅲ级(P=0.005), 侧支代偿Ⅰ级的TTP高于侧支代偿Ⅲ级(P=0.015), 余指标两两比较差异无统计学意义。侧支代偿Ⅰ级、侧支代偿Ⅱ级及侧支代偿Ⅲ级的CBV、DLY差异无统计学意义(P>0.05)。结论 4D CTA-CTP对烟雾病及烟雾综合征患者的侧支循环评价能力与DSA相当, 并可以全面评估脑血流动力学情况, 对病情监测具有较高的临床价值。
Objective To explore the significance of four-dimensional CT angiography(4D CTA)and CT perfusion(CTP)imaging in evaluating collateral circulation grades in patients with moyamoya disease and moyamoya syndrome and their relationship with cerebral hemodynamics.Methods The clinical and imaging data of 32 patients with moyamoya disease and moyamoya syndrome in Beijing Hospital from January 2017 to January 2022 were retrospectively analyzed.All patients underwent 4D CTA-CTP imaging.Collateral circulation was scored on CTA images by using Alberta stroke program early CT score system,and on digital subtraction angiography(DSA)images by using American society of interventional and therapeutic neuroradiology/Society of interventional radiology score system,respectively.The patients were divided intoⅠ-Ⅲcirculation compensation grades based on collateral circulation score.Regions of interest were delineated at basal ganglia on perfusion maps and the perfusion parameters were obtained including cerebral blood volume(CBV),cerebral blood flow(CBF),mean transit time(MTT),mean transit time(TTP)and delay time(DLY).The Kruskal-Wallis test was used to compare the perfusion parameters in different collateral circulation grades,and pairwise comparison was performed with Bonferroni correction.Kappa and Spearman tests were used to analyze the consistency and correlation of 4D CTA and DSA in the classification of collateral circulation.Results 4D CTA and DSA had a moderate consistency(Kappa=0.693,P<0.001)and a strong correlation(r=0.805,P<0.001)in evaluating collateral grades.There were statistically significant differences in CBF,MTT and TTP among collateral compensation gradeⅠ,gradeⅡand gradeⅢ(H values were 7.91,11.69,8.93;P values were 0.019,0.003 and 0.012,respectively).Further pairwise comparison showed that the CBF of collateral compensation gradeⅠwas lower than that of gradeⅢ(P=0.015),MTT of gradeⅡwas higher than that of gradeⅢ(P=0.005),and TTP of gradeⅠwas higher than that of gradeⅢ(P=0.015).There was no statistical significance of other indicators in pairwise comparison.There were no significant differences in CBV and DLY among collateral compensation gradeⅠ,gradeⅡand gradeⅢ(P>0.05).Conclusions 4D CTA-CTP is equivalent to DSA in evaluating collateral circulation in patients with moyamoya disease and moyamoya syndrome.It can also evaluate the cerebral hemodynamics comprehensively,which has high clinical significance for disease monitoring.
作者
逯瑶
李玲
曹若瑶
何祎
王艳华
杨希孟
刘慧菁
陈涓
Yao Lu;Ling Li;Ruoyao Cao;Yi He;Yanhua Wang;Ximeng Yang;Huijing Liu;Juan Chen(the Key Laboratory of Geriatrics,Beijing Institute of Geriatrics,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing Hospital/National Center of Gerontology of National Health Commission,Beijing 100730,China;Department of Radiology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Graduate School of Peking Union Medical College,Beijing 100730,China;Department of Radiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Neurosurgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Neurology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Science,Beijing 100730,China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2023年第3期252-258,共7页
Chinese Journal of Radiology
基金
中华国际医学交流基金会“2020SKY影像科研基金”(Z-2014-07-2003-02)
2020北京医院“国家自然科学基金预研专项”(BJ-2020-131)。
