目的

探讨CT脑灌注成像（CTP） 技术评估重度颈动脉狭窄患者介入治疗术前后脑灌注变化。

方法

采用64层CT对22 例颈动脉狭窄患者行术前CT血管造影术（CTA） 联合CTP，术后行CTP， 评估颈动脉支架植入（CAS） 术前与术后脑血流量（CBF）、 脑血容量（CBV） 、 平均通过时间（MTT） 的变化情况。

结果

19 例单侧颈动脉狭窄患者术前的双侧脑灌注有明显差异， CBF降低［患侧（21.90±3.37）ml/（100 g·min）、健侧（37.17±6.34）ml/（100 g·min），t=13.445，P﹤0.001］，MTT延长［患侧（8.44±1.02） s、 健侧（5.75±0.81） s， t=9.605， P﹤0.001］， CBV 无明显差异［患侧（2.03±0.31） ml/100 g、 健侧（2.14±0.25） ml/100 g， t=1.204， P=0.2365］； 而CAS术后患侧脑灌注参数明显正常化。

结论

CTA结合CTP能够从功能学方面较为客观地评估重度颈动脉狭窄患者的脑血流动力学变化， 定量的脑灌注参数使其成为CAS 术后随访的有力工具。

Objective

To evaluate the change of cerebral perfusion of patients with severe carotid stenosis before and after undergoing carotid artery stent placement（CAS）with CT perfusion（CTP）.

Methods

Twenty-two patients with carotid artery stenosis were underwent cerebral perfusion CT before and after the stentplacement procedure.Cerebral blood volume（CBV），cerebral blood flow（CBF）and mean transit time（MTT）values were measured.

Results

There was significant difference in preoperative bilateral cerebral perfusion of 19 cases with unilateral carotid artery stenosis.CBF of affected side was lower than that of uninjured side（21.90±3.37 vs 37.17±6.34，t=13.445，P﹤0.001）.MTT of affected side was longer than that of uninjured side（8.44±1.02 vs 5.75±0.81，t=9.605，P﹤0.001）.There was no significant difference between affected side and uninjured side（2.03±0.31 vs 2.14±0.25，t=1.204，P=0.2365）.The perfusion parameters of affected side was normalizing after CAS.

Conclusions

CTA combined with CTP is a useful technique for the assessment of the hemodynamic modifications in patients with severe carotid stenosis.The quantitative evaluation of cerebral perfusion makes it a reliable tool for the follow-up of patients who undergo CAS.