Objective: To investigate the change of cerebral microcirculation of chronic cerebral circulation insufficiency(CCCI) patients and the relationship between CCCI and crossed cerebellar diaschisis(CCD)by using 320-detector row of low-dose volume CT perfusion imaging. Methods: A total of 158 patients (103 males, 55 females, from 45 to 82 years old, the mean age was 62.9) with symptoms of CCCI were admitted to the First Affiliated Hospital of Wenzhou Medical University from June 2013 to January 2016. Low-dose CTP imaging of whole brain was performed to them using 320-detector row volume CT scanner. The perfusion parameters such as cerebral blood flow(CBF), cerebral blood volume(CBV), mean transit time(MTT), time to peak(TTP) and DLY in both cerebral blood supply areas and cerebellum were got, so were the 4-dimensional CTA images, and rCBF, rCBV, rMTT and rTTP were calculated by ipsilateral/contralateral value. Comparative t-test and independent t-test were applied to analyzing these parameters quantitatively.Chi-square test and Logistic regression model were applied to analyzing the related clinical risk factors. Results: (1) All 108 patients in CCCI group showed asymmetric perfusion within two cerebral hemispheres in CTP images. The CBF, CBV of diseased side were lower than the contralateral mirror area (t(CBF)=-12.89, t(CBV)=-7.031, P(CBF, CBV)<0.001); the MTT of the diseased side was shorter than the contralateral mirror area (t(MTT) =13.310, P(MTT)<0.001); the TTP of the diseased side was longer than the contralateral mirror area (t(TTP)=-4.012, P(TTP)<0.001). The rCBF and rCBV of CCCI group were lower than that in non-CCCI group (t(rCBF)=3.079, t(rCBV)=2.760, P(rCBF, rCBV)<0.01), while the rTTP of CCCI group was longer than that in non-CCCI group (t(rTTP)=4.846, P(rTTP)<0.001). (2)The results of Chi-square test showed that the differences of gender (χ(2)=4.036, P=0.045), hyperlipidemia (χ(2)=7.687, P=0.006), as well as smoking (χ(2)=11.868, P=0.001) had statistical significance between CCCI group and non-CCCI group.Multi-factor Logistic regression analysis showed that hyperlipidemia (OR value=3.736, P=0.016) and smoking (OR value=4.641, P=0.01) were the risk factors of CCCI, while gender had no relationship with it.(3)The incidence of CCD was 18.5% in the CCCI group, and at the same time, the supratentorial corresponding blood supply areas were classified.A total of 10(34.5%) cases were in blood supply area of posterior cerebral artery, 6(20.7%) cases were in blood supply area of middle cerebral artery, 12(41.4%) cases were of anterior cerebral artery, while only 1(3.5%) case was of basal ganglia, in which 4 cases were in blood supply area of posterior cerebral artery, another 4 cases were middle cerebral artery, 7 cases were of anterior cerebral artery and no case of basal ganglia respectively leading CCD alone. Conclusions: CTP could display the microcirculation situation of abnormal brain tissue perfusion area intuitively and quantitatively. Additionally, it could reflect the degree of relationship between cerebral several blood supply areas and cerebellum.
目的： 应用320排低剂量容积CT灌注成像(CTP)研究慢性脑供血不足(CCCI)脑组织微循环的改变及CCCI与小脑神经机能联系不能(CCD)的关联。 方法： 应用320排容积CT对2013年6月至2016年1月温州医科大学附属第一医院158例具有CCCI症状者行低剂量全脑CTP，男103例、女55例，年龄45～82岁，平均年龄62.9岁。同时获得大脑各供血区及小脑的脑血流(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)和DLY等灌注参数和动态4D-CTA图像。计算相对灌注参数值rCBF、rCBV、rMTT及rTTP(患侧/健侧)，采用配对t检验及两独立样本t检验对各组CBF、CBV、MTT、TTP和DLY进行定量分析。利用χ(2)检验及Logistic回归模型分析CCCI的临床相关危险因素。 结果： (1)CCCI组108例患者CTP呈现两侧大脑半球灌注不对称。患侧CBF、CBV低于对侧镜像区(t(CBF)＝－12.89、t(CBV)＝－7.031，P(CBF，CBV)<0.001)；MTT短于对侧镜像区(t(MTT)＝13.310，P(MTT)<0.001)；TTP长于对侧镜像区(t(TTP)＝－4.012，P(TTP)<0.001)。CCCI组rCBF、rCBV低于非CCCI组(t(rCBF)＝3.079, t(rCBV)＝2.760，P(rCBF，rCBV)<0.01)；CCCI组rTTP长于非CCCI组(t(rTTP)＝4.846，P(rTTP)<0.001)。(2)χ(2)检验显示性别(χ(2)＝4.036，P＝0.045)、高血脂(χ(2)＝7.687，P＝0.006)及吸烟(χ(2)＝11.868，P＝0.001)在CCCI组及非CCCI组中的差异有统计学意义。多因素Logistic回归分析结果显示高血脂(OR值＝3.736，P＝0.016)、吸烟(OR值＝4.641，P＝0.01)是CCCI的危险因素，而性别与之无相关性。(3)CCCI组CCD发生率为18.5%，同时CCD发生对应幕上的缺血区分别为大脑后动脉供血区10例(34.5%)、大脑中动脉供血区6例(20.7%)、大脑前动脉供血区12例(41.4%)、基底节区1例(3.5%)；其中单独供血区所引发的CCD分别为大脑后动脉供血区4例(13.8%)、大脑中动脉供血区4例(13.8%)、大脑前动脉供血区7例(24.1%)、基底节区0例。 结论： CTP可直观和定量显示CCCI患者脑组织异常灌注区微循环状况的同时，还可反映各个脑区与小脑联系程度。.
Keywords: CT perfusion imaging; Chronic cerebral circulation insufficiency; Crossed cerebellar diaschisis.