Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2012 Dec;75(12):649-53. doi: 10.1016/j.jcma.2012.08.008. Epub 2012 Nov 7.
Cerebral perfusion can be evaluated using a computed tomography (CT) scan by intravenous bolus injection of contrast media. The purpose of this study was to investigate the value of CT perfusion (CTP) in follow-up of extracranial-intracranial (EC-IC) bypass surgery.
We retrospectively reviewed pre- and postoperative CTP studies in 14 patients who received EC-IC bypass surgery because of cerebral arterial occlusion or stenosis. Brain areas showing prolongation of the mean transit time (MTT) were automatically identified and quantitatively measured.
All 14 patients showed MTT prolongation in the preoperative CTP study. In 13 patients, a reduction in brain volume with MTT prolongation was noted during postoperative CTP. These 13 patients had a patent EC-IC anastomosis, and 42 ± 21% of the brain area with MTT prolongation returned to normal MTT during CTP 7 ± 4 days (range 2-13 days) after surgery. On clinical follow up of 41 ± 16 months (range 14-60 months), no stroke or transient ischemic attack was noted after bypass surgery in these 13 patients. The brain volume with MTT prolongation did not decrease in just one patient whose EC-IC anastomosis was not patent, and the patient suffered a minor stroke during surgery.
Quantitative results for the brain area with MTT prolongation were positively correlated with improvement in brain perfusion shown on MTT, EC-IC bypass patency, and patient outcome.
脑灌注可通过静脉注射对比剂的计算机断层扫描（CT）进行评估。本研究旨在探讨 CT 灌注（CTP）在颅内外（EC-IC）旁路手术后随访中的价值。
我们回顾性分析了 14 例因脑动脉闭塞或狭窄而行 EC-IC 旁路手术的患者的术前和术后 CTP 研究。自动识别并定量测量显示平均通过时间（MTT）延长的脑区。
所有 14 例患者在术前 CTP 研究中均显示 MTT 延长。在 13 例患者中，术后 CTP 显示伴有 MTT 延长的脑体积减少。这 13 例患者的 EC-IC 吻合口通畅，42±21%的 MTT 延长脑区在术后 7±4 天（范围 2-13 天）的 CTP 中恢复正常 MTT。在 41±16 个月（范围 14-60 个月）的临床随访中，这 13 例患者在旁路手术后均未发生卒中或短暂性脑缺血发作。吻合口不通畅的 1 例患者 MTT 延长的脑体积没有减少，该患者在手术中发生了轻微卒中。
MTT 延长脑区的定量结果与脑灌注改善、EC-IC 旁路通畅性和患者预后呈正相关。
