本文關(guān)鍵詞： 造影劑增強(qiáng) CT灌注成像 碘普羅胺 全腦血管造影術(shù) 血腦屏障　出處：《廣西醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討腦梗死患者全腦血管造影術(shù)后即刻頭顱CT腦梗死區(qū)高密度灶的可能原因。 方法連續(xù)收集34例全腦血管造影后即刻頭顱CT腦梗死患者,CT高密度灶患者于24小時(shí)內(nèi)復(fù)查頭顱CT觀察高密度灶變化情況。根據(jù)CT表現(xiàn)按有無高密度灶分為高密度灶組和無高密度灶組。造影后當(dāng)天行腰穿檢查并留取腦脊液,采用紫外分光光度法檢測腦脊液碘普羅胺濃度,比較高密度灶組和無高密度灶組患者腦脊液碘普羅胺濃度有無差異。造影后三天內(nèi)行腦CTP檢查了解梗死區(qū)及高密度灶處的血流灌注情況。 結(jié)果34例患者中發(fā)現(xiàn)CT高密度灶15例,CT高密度灶發(fā)生率為44%。高密度灶組和無高密度灶組在性別、年齡、高血壓病、糖尿病、心臟病、高血脂癥等基線資料比較,差別均無統(tǒng)計(jì)學(xué)意義。造影后即刻頭顱CT高密度灶表現(xiàn)多樣,可分別在腦皮質(zhì)、腦實(shí)質(zhì)、蛛網(wǎng)膜下腔及腦室出現(xiàn)高密度灶,24小時(shí)內(nèi)CT復(fù)查高密度灶消退,其中皮質(zhì)高密度灶3例,放射冠高密度灶2例,基底節(jié)區(qū)高密度灶6例,混合型高密度灶4例。高密度灶組(n=15)患者的頻數(shù)分布以腦梗死后第二周、第三周最多；高密度灶組(n=15)和無高密度灶組(n=19)造影過程中造影劑平均劑量分別為104.0±9.5ml和89.2±8.3ml,兩組間比較差別有統(tǒng)計(jì)學(xué)意義(P0.05)。造影劑劑量100ml的11例患者有9例發(fā)現(xiàn)高密度灶；造影劑劑量≤100ml的23例患者中有6例發(fā)現(xiàn)高密度灶,差別具有統(tǒng)計(jì)學(xué)意義,造影劑劑量100ml患者較造影劑劑量≤100ml患者高密度灶發(fā)生率高(81.8%vs26.1%)。高密度灶組(n=4)和無高密度灶組(n=4)腦脊液碘普羅胺平均濃度分別為209±50ug/ml和29±6ug/ml；高密度灶組碘普羅胺濃度高于無高密度組,差別具有統(tǒng)計(jì)學(xué)意義(P0.05)。高密度灶組與無高密度灶組患側(cè)CBF、CBV均低于對照側(cè),MTT、TTP均較對照側(cè)延長,差別均具有統(tǒng)計(jì)學(xué)意義(P＜0.05)；高密度灶處CBV高于對照側(cè),CBF低于對照側(cè),MTT及TTP均較對照側(cè)延長,差別均具有統(tǒng)計(jì)學(xué)意義(P＜0.05) 結(jié)論腦梗死患者全腦血管造影術(shù)后即刻頭顱CT易出現(xiàn)高密度灶。血腦屏障破壞是腦梗死患者全腦血管造影術(shù)后即刻頭顱CT高密度灶的可能原因。造影劑神經(jīng)毒性作用和腦缺血誘導(dǎo)局部血管增生可能是致血腦屏障破壞和造影劑外溢的重要因素。高密度灶處CBV升高,提示CBV可作為反映腦梗死患者全腦血管造影術(shù)后CT高密度灶的一項(xiàng)敏感指標(biāo)。
[Abstract]:Objective to explore the possible causes of high density cerebral infarction in cerebral infarction patients. Methods 34 consecutive patients with cerebral infarction were collected immediately after cerebral angiography. According to the CT findings, the patients were divided into high-density focus group and non-high-density focus group according to CT findings. Keep cerebrospinal fluid. The concentration of iopramide in cerebrospinal fluid was determined by ultraviolet spectrophotometry. The cerebrospinal fluid (CSF) of patients with high density focus and no high density focus were compared. Cerebral CTP examination was performed within 3 days after angiography to find out the blood flow perfusion in the infarcted area and the high density focus. Results the incidence of high density CT focus was 44 in 15 of 34 patients. Sex, age, hypertension, diabetes, heart disease were found in high density focus group and no high density focus group. Hyperlipidemia and other baseline data, the difference was not statistically significant. Immediately after the contrast, CT high-density foci of various manifestations, can be in the cerebral cortex, brain parenchyma, subarachnoid space and ventricle high-density lesions. Within 24 hours CT examination showed that the high-density foci disappeared in 3 cases of cortical hyperdense foci 2 cases of radiation-coronal high-density foci and 6 cases of basal ganglia high-density foci. There were 4 cases of mixed high-density foci. The frequency distribution of the patients in the high-density group was the second week after cerebral infarction and the most in the third week. The average dose of contrast agent was 104.0 鹵9.5ml and 89.2 鹵8.3ml, respectively. The difference between the two groups was statistically significant (P 0.05). High density foci were found in 9 out of 11 patients with 100 ml contrast agent. Among the 23 patients whose dose of contrast agent 鈮，

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