摘要
目的:应用超声造影评估无症状性颈内动脉(ICA)重度狭窄患者行颈动脉支架置入术(CAS)后的脑灌注改变的价值。方法:选取2020年7月-2022年12月我院行CAS术的单侧ICA重度狭窄患者18例,男14例,女4例,平均年龄(62.6±7.3)岁。患者无临床症状或仅表现为轻度头痛、头晕。分别于CAS术前、术后12 h内行双侧经颅超声造影检查,选取基底节区作为感兴趣区(ROI)进行时间-强度曲线分析,测量参数为达峰时间(TTP),平均通过时间(MTT),上升斜率(WIS),峰值强度(PI),曲线下面积(AUC),计算患侧与健侧参数的相对值rTTP,rMTT,rWIS,rPI,rAUC,及CAS术后改变量ΔrTTP,ΔrMTT,Δr WIS,Δr PI,ΔrAUC。比较CAS术前、术后参数绝对值与相对值,并对CAS术前相对值与术后改变量的相关性进行分析。结果:CAS术前,患侧TTP(22.17±3.34) s,MTT (33.73±5.88) s均较健侧延长,WIS (1.75±0.68) dB/s低于健侧(P<0.05),而PI,AUC双侧比较无统计学差异;CAS术后,患侧参数绝对值仅WIS (2.14±0.69) dB/s较术前增高(P<0.05);相对值rTTP (1.02±0.08),r MTT(0.96±0.10)低于术前,rWIS (1.02±0.17)较术前增高(P<0.05);CAS术前相对值rTTP,rMTT,rWIS分别与术后改变量ΔrTTP,Δr MTT,ΔrWIS存在负相关关系(r值分别为-0.592,-0.754及-0.730)。结论:超声造影可评估无症状性ICA重度狭窄患者CAS术后脑灌注的改变,术后双侧灌注差异性降低,且患侧术前脑灌注受损程度越重,术后改善越明显。
Objective:To evaluate cerebral perfusion changes after CAS in patients with asymptomatic severe internal carotid artery(ICA)stenosis by contrast-enhanced ultrasound.Methods:Eighteen patients(14 men,4 women;mean age 62.6±7.3 years)with unilateral severe ICA stenosis undergoing CAS from July 2020 to December 2022 were enrolled.All patients had no clinical symptoms or only mild headache and dizziness.Bilateral transcranial contrast-enhanced ultrasound were per-formed within 12 h before and after CAS.Basal ganglia was selected as the region of interest(ROI)for time-intensity curve analysis.Time to peak(TTP),mean transit time(MTT),wash-in slope(WIS),peak intensity(PI)and area under curve(AUC)were measured and the relative values based on the comparison between ipsilateral and contralateral side-rTTP,rMTT,rWIS,rPI,rAUC were calculated.Changes in relative values after CAS-ΔrTTP,ΔrMTT,ΔrWIS,ΔrPI,ΔrAUC were derived.The absolute and relative parameters prior and post to CAS were compared and the correlation analysis was done between relative values before CAS and the changes after CAS.Results:Before CAS,a delay of TTP(22.17±3.34)s and MTT(33.73±5.88)s as well as a lower value of WIS(1.75+0.68)dB/s were demonstrated on the ipsilateral side compared with the contralateral side(P<0.05),while no significant interhemispheric difference was found in PI and AUC.After CAS,only WIS(2.14±0.69)dB/s of the ipsilateral side was higher than the preprocedural value(P<0.05)among all absolute values.Relative values of rITP(1.02+0.08)and rMTT(0.96+0.10)were reduced and rWIS(1.02+0.17)was increased compared with values before CAS(P<0.05).Relative values of rTTP,rMTT and rWIS before CAS were negatively correlated with ΔrTTP,ΔrMTT and ΔrWIS,respectively(r=-0.592,-0.754 and-0.730,respectively).Conclusion:Contrast-enhanced ultrasound can evaluate the change of the cerebral perfusion of patients with asymptomatic severe ICA stenosis after CAS.The interhemispheric difference was reduced afer CAS.A stronger perfusion impairment of the ipsilateral side before CAS had a greater improvement afterwards.
作者
程令刚
康睿君
何文
张巍
张琳
CHENG Ling-gang;KANG Rui-jun;HE Wen;ZHANG Wei;ZHANG Lin(Department of Ultrasound,Beijing Tiantan Hospital,Capital Medical University,Beijing 100160,China)
出处
《中国临床医学影像杂志》
CAS
CSCD
北大核心
2024年第8期533-536,共4页
Journal of China Clinic Medical Imaging
基金
国家自然科学基金(81730050、82271995)。
