应用CT灌注成像技术辨别瘤性蛛网膜下腔出血患者可逆脑缺血与脑缺血向脑梗死进展研究.docVIP

应用CT灌注成像技术辨别瘤性蛛网膜下腔出血患者可逆脑缺血与脑缺血向脑梗死进展研究 　　【摘要】 目的：通过分析瘤性蛛网膜下腔出血患者发生延迟性脑缺血（DCI）时，SAH周围脑实质CT灌注变化情况及随访影响资料（如CT、MRI），以探讨应用CT灌注成像技术（CTP）辨别瘤性蛛网膜下腔出血患者可逆脑缺血与脑缺血向脑梗死进展过程的临床价值。方法：回顾性分析2013年9月-2015年10月本院神经外科38例aSAH后DCI的影像学资料。所有患者在临床恶化时均行头CT、CTP检查并应用CT或MRI进行随访观察。通过CTP定性分析，视觉评估随访中出现灌注缺损和脑梗死在95%可信区间的阳性预测值（PPV）和阴性预测值（NPV）。在定性分析中，应用ROC曲线比较了有无脑梗死组最低灌注区域的参考值、各参数绝对值和相对值曲线下面积。结果：38例DCI患者出现脑梗死17例，无脑梗死21例。定量分析：随访中有脑梗死且灌注缺损共14例（82.35%），有灌注缺损但无脑梗死共 　　7例（33.33%）（P0.05）；灌注缺损发展为脑梗死的PPV和NPV分别为66.67%（95%CI：67%～80%）和82.35%（95%CI：70%～94%）。定量分析：CBF最小灌注值为17.63 mL/（100 g?min），其PPV和NPV分别为65.48%和76.32%。结论：CTP在辨别瘤性蛛网膜下腔出血可逆脑缺血与脑缺血进展为脑梗死方面具有一定的临床应用价值。并且，CTP定性分析较定量分析效果要好。 　　【关键词】 CT灌注成像； 瘤性蛛网膜下腔出血； 延迟性脑缺血； 脑梗死 　　【Abstact】 Objective：To study cerebral perfusion in surrounding brain parenchyma and follow-up imaging within delay cerebral ischemia after aneurismal subarachnoid hemorrhage，explore whether CT perfusion can distinguish between reversible ischemia and ischemia progressing to cerebral infarction.Method：Imaging data of 38 DCI after aSAH patients during September 2013 to October 2015 in our hospital were retrospectively reviewed.All patients underwent CT and CTP during clinical deterioration and follow up by CT or MRI.In qualitative CTP analyses，we calcultated positive and negative predictive value with 95% confidence intervals（95%CI） of perfusion deficit for infraction on follow-up imaging.In quanlitative CTP analyses，we compared perfusion values of the least perfusion area between patients with and without infraction by ROC curves.Result：The trial included 38 patients，17 patients with infraction and 21 patients without infraction.14 of 17 patients with infraction and 7 of 21 patients without infraction on follow-up had a perfusion deficit during clinical deterioration（P0.05）.A perfusion deficit had a PPV of 66.67%（95%CI：67%-80%）and a NPV of 82.35%（95%CI： 70%-94%） for infraction on follow-up.In quanlitative CTP analyses，an absolute CBF threshold of 17.63 mL/（100 g?min） had a PPV of 65.48% and