CT angiography and perfusion CT in cerebral vasospasm after subarachnoid hemorrhage.
CT angiography and perfusion CT in cerebral vasospasm after subarachnoid hemorrhage.
复制标题
CT血管造影和灌注CT在蛛网膜下腔出血后脑血管痉挛中的应用
DOI：
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发表时间：
2007
期刊：
影响因子：
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通讯作者：
R. Meuli
中科院分区：
文献类型：
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作者：
S. Binaghi;M. L. Colleoni;Philippe Maeder;A. Uské;Luca Regli;A. Dehdashti;Pierre Schnyder;R. Meuli
背景和目的
我们研究了多断层 CT 血管造影 (MSCTA) 和灌注 CT (PCT) 与动脉瘤性蛛网膜下腔出血继发血管痉挛特征之间的关系。
材料和方法
通过数字减影血管造影 (DSA) 检查的 27 例有症状的脑血管痉挛患者中，18 例同时接受了脑 PCT 和 MSCTA。其余9例只能进行PCT或MSCTA。将 MSCTA 与 DSA 进行比较，以检测和表征 286 个颅内动脉段的血管痉挛。目视检查 PCT 图的平均通过时间、相对脑血流量和相对脑血容量异常，并与 DSA 检测到的相应区域血管痉挛进行定性比较。
结果
血管痉挛分为两类：轻度至中度和重度。 MSCTA 对血管痉挛的描述在 A2 和 M2 动脉段水平上表现出最佳的敏感性、特异性和准确性（各为 100%），而颈动脉虹吸管（分别为 45%、100% 和 85%）则相反。 MSCTA 表征血管痉挛严重程度的敏感性、特异性和准确性对于轻中度血管痉挛分别为 86.8%、96.8% 和 95.2%，对于重度血管痉挛分别为 76.5%、99.5% 和 97.5%。 9 名患者的 PCT 异常与重度血管痉挛有关，2 名患者的 PCT 异常与轻至中度血管痉挛有关。PCT 检测血管痉挛的敏感性、特异性和准确性，对于重度血管痉挛分别为 90%、100% 和 92.3%，对于轻中度血管痉挛分别为 20%、100% 和 38.5%血管痉挛。
结论
MSCTA/PCT可以评估脑血管痉挛的部位、严重程度及其相关的灌注异常。它可以识别具有迟发性缺血风险的严重血管痉挛，从而指导侵入性治疗。
BACKGROUND AND PURPOSE
We investigated the association of multisection CT angiography (MSCTA) and perfusion CT (PCT) for the characterization of vasospasm secondary to aneurysmal subarachnoid hemorrhage.
MATERIALS AND METHODS
Among 27 patients with symptomatic cerebrovascular vasospasm investigated by digital subtraction angiography (DSA), 18 underwent both cerebral PCT and MSCTA. For the remaining 9, only PCT or MSCTA could be performed. MSCTA was compared with DSA for the detection and characterization of vasospasm on 286 intracranial arterial segments. PCT maps were visually reviewed for mean transit time, relative cerebral blood flow, and relative cerebral blood volume abnormalities and were qualitatively compared with the corresponding regional vasospasm detected by DSA.
RESULTS
Vasospasm was grouped into 2 categories: mild-moderate and severe. The depiction of vasospasm by MSCTA showed the best sensitivity, specificity, and accuracy at the level of the A2 and M2 arterial segments (100% for each), in contrast to the carotid siphon (45%, 100%, and 85% respectively). The characterization of vasospasm severity by MSCTA showed a sensitivity, specificity, and accuracy of 86.8%, 96.8%, and 95.2%, respectively, for mild-moderate vasospasm, and 76.5%, 99.5%, and 97.5%, respectively, for severe vasospasm. The PCT abnormalities were related to severe vasospasm in 9 patients and to mild-to-moderate vasospasm in 2. The sensitivity, specificity, and accuracy of PCT in detecting vasospasm were 90%, 100%, and 92.3%, respectively, for severe vasospasm, and 20%, 100%, and 38.5%, respectively, for mild-moderate vasospasm.
CONCLUSION
MSCTA/PCT can assess the location and severity of cerebrovascular vasospasm and its related perfusion abnormalities. It can identify severe vasospasm with risk of delayed ischemia and can thus guide the invasive treatment.