外伤后早期CTP对脑挫裂伤评估的初步研究

袁涛; 全冠民; 钟洪波; 刘怀军; 王颖杰; 齐战元; 魏志刚

中国临床医学影像杂志 ›› 2010, Vol. 21 ›› Issue (11) : 765-769.

论著

外伤后早期CTP对脑挫裂伤评估的初步研究

袁涛1，全冠民1，钟洪波2，刘怀军1，王颖杰1，齐战元3，魏志刚1

作者信息 +

Early evaluation of CT perfusion in cerebral contusion and laceration: an initial study

YUAN Tao1, QUAN Guan-min1, ZHONG Hong-bo2, LIU Huai-jun1, WANG Ying-jie1, QI Zhan-yuan3, WEI Zhi-gang1

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摘要

目的：观察外伤后48h内脑挫裂伤区CT灌注（CTP）脑血流量（CBF）、血容量（CBV）、平均通过时间（MTT）参数的变化，并确定CTP各参数图对1周后病变面积预测的准确性。方法：对18例48h内就诊的患者行CT平扫（NCCT）与CTP检查，首次检查1周后复查NCCT，测量下列4个区域的CBF、CBV及MTT：脑挫裂伤内出血区、低密度区、灶周NCCT密度正常及对侧镜像区脑实质。测量首次NCCT、CBF、CBV及MTT图像上病变面积，并与1周复查NCCT同层图像所见比较。结果：脑挫裂伤内出血区及低密度区CBF[分别为（2.42±1.62）ml/（100g·min）及（10.58±6.45）ml/（100g·min）]及CBV[分别为（0.62±0.41）ml/100g及（1.53±0.47）ml/100g]均明显下降，以低密度区参数变化范围最大；挫裂伤内出血及低密度区MTT明显延长[分别为（16.10±8.45）s及（9.69±6.31）s]。初诊时NCCT上异常密度区1周后有明显增大，以CBF与CBV图所见的异常灌注面积与1周复查时NCCT吻合度最佳（66.67%与50%）。初诊NCCT与MTT图（分别为77.78%与72.22%）常低估1周后NCCT所见病变面积。结论：脑挫裂伤血流灌注明显低于正常，以出血区CBF与CBV下降明显，而低密度区CBF变化范围最大。CBF与CBV图可较好地预测1周后病变的面积。

Abstract

Objective: To probe the alteration of cerebral blood flow(CBF), cerebral blood volume(CBV) and mean transit time(MTT) of cerebral contusion and laceration with CT perfusion(CTP) within 48 hours after closed traumatic brain injury(TBI). And to investigate the value of CTP on predicting the lesion size on non-contrast CT(NCCT) one week later. Methods: NCCT and CTP were performed in 18 patients suffering from cerebral contusion and laceration within 48 hours after TBI. NCCT was repeatedly made 1 week thereafter. CBF, CBV and MTT were measured in three different regions: the hemorrhagic area, the surrounding hypodense region, and the perilesional normal-appearing parenchyma. All these parameters of the mirror region of contralateral hemisphere were also recorded. The area with abnormal density or abnormal color on initial NCCT and CBF-, CBV-, and MTT-derived maps were measured and compared with the area measured on the same slice on NCCT 1 week later. Results: The CBF and CBV of hemorrhagic areas and its surrounding hypodense region of cerebral contusion and laceration decreased obviously[the CBF were (2.42±1.62)ml/(100g·min) and (10.58±6.45)ml/(100g·min) separately and the CBV were (0.62±0.41)ml/100g and (1.53±0.47)ml/100g respectively]. The CBF and CBV parameters of hypodense region were more variable. MTT of hemorrhagic area and its surrounding hypodense region were prolonged predominantly[(16.10±8.45)s and (9.69±6.31)s separately]. The whole area of cerebral contusion and laceration showed noticeably enlarged during the first week after trauma. In comparison with the initial NCCT and MTT map, CBF and CBV maps were proved to be more congruent with the findings of NCCT at 1 week(66.67% and 50% respectively). According to initial NCCT and MTT maps, the area of lesions were more often underestimated compared to the follow-up CT(77.78% and 72.22% respectively). Conclusions: The perfusion of cerebral contusion and laceration decreased obviously, with pronounced alteration on CBF and CBV at the hemorrhagic regions. The paramaters of CBF and CBV were more variable than those of other areas. This study suggested that CBF and CBV maps could be more accurate for early predicting the area of lesions 1 week after TBI.

导出引用

袁涛;全冠民;钟洪波;刘怀军;王颖杰;齐战元;魏志刚. 外伤后早期CTP对脑挫裂伤评估的初步研究[J]. 中国临床医学影像杂志. 2010, 21(11): 765-769

YUAN Tao;QUAN Guan-min;ZHONG Hong-bo;LIU Huai-jun;WANG Ying-jie;QI Zhan-yuan;WEI Zhi-gang. Early evaluation of CT perfusion in cerebral contusion and laceration: an initial study[J]. Journal of China Clinic Medical Imaging. 2010, 21(11): 765-769

中图分类号： Ｒ651.15 Ｒ814.42