|
|
An analysis of multi-modality CT imaging and high-risk clinical factors of chronic cerebral hypoperfusion |
XU Haoli1, HE Wenwen1, JIANG Mengmeng1, LIN Wenxiu1, XIA Huwei1, ZHANG Zirui1, ZHAO Mengjing1, HUANG Wangle1, FU Pingping1, ZHUGE Qichuan2, CHEN Weijian1 |
1.Radiography Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China; 2.Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China |
|
Cite this article: |
XU Haoli,HE Wenwen,JIANG Mengmeng, et al. An analysis of multi-modality CT imaging and high-risk clinical factors of chronic cerebral hypoperfusion[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2019, 49(9): 654-660.
|
|
Abstract Objective: To evaluate the microcirculation and hemodynamic changes in patients with chronic cerebral hypoperfusion (CCH) via one-stop low-dose multi-modality CT including CT perfusion (CTP) and CT angiography (CTA), and to analyze the clinical risk factors. Methods: Whole-brain CTP imaging was performed on 266 patients with suspected diagnosis of CCH using 640 multi-slice CT. Following the post-processing, cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), delay time (DT) and Four-dimensional CTA images were acquired. The relative perfusion parameters (rCBF, rCBV, rTTP and rDT) were calculated and the stenosis degree of brain arteries was evaluated. The perfusion parameter differences between two hemispheres were analyzed by comparative t-test; the perfusion parameter differences between hypoperfusion group and normal perfusion group were analyzed by independent t-test; the difference on stenosis degree of supplying blood vessel between hypoperfusion group and normal perfusion group were analyzed by the rank sum test and the clinical risk factors were analyzed by Chi-square test and logistic regression. Results: ①In the hypoperfusion group, 184 patients demonstrated perfusion asymmetry on both hemispheres. CBF and CBV of the affected side were lower than that of contralateral side, while TTP and DT were prolonged, the differences of all perfusion parameters between two sides had statistical significance (P<0.01). Among these cases, 98 cases had anterior circulation insufficient, 61 cases had posterior circulation insufficient, and 25 cases had multi-region circulation insufficient. ②rCBF and rCBV of the hypoperfusion group were lower than that of the normal perfusion group, while rTTP and rDT were higher than the latter. The perfusion parameters of CCH group were 0.75±0.44, 0.76± 0.56, 1.16±0.22, and 1.56±0.34; the perfusion parameters of normal perfusion group were 0.93±0.51, 0.92±0.09, 1.03±0.07, and 1.06±0.17. The difference between two groups had statistical significance (t=-3.943, -3.862, 2.790, 4.558, P<0.01). ③In 184 cases of hypoperfusion, 24 cases were mild stenosis, 47 cases moderate stenosis, 65 cases severe stenosis and 48 cases occlusion on CTA. Among 82 normal perfusion cases, 54 cases were mild stenosis, 21 cases moderate stenosis, 5 cases severe stenosis and 2 cases occlusion on CTA. The differences in artery stenosis between two groups had statistical significance (P<0.01). ④The incidence of diabetes, hyperlipidemia, and smoke was statistically different between hypoperfusion group and NCCH group (P<0.05). Confirmed by multi-factor logistic regression analysis, smoke and hyperlipidemia were high risk factors of hypoperfusion. Conclusion: Multi-modality CT imaging can not only demonstrate the degree of cerebral artery stenosis, but also directly and quantitatively reflect the microcirculation perfusion of brain tissue in CCH patients, and provide an objective imaging basis for the diagnosis and prevention of CCH.
|
Received: 26 March 2019
|
|
|
|
|
[1] BENEDICTUS M R, LEEUWIS A E, BINNEWIJZEND
M A, et al. Lower cerebral blood flow is associated with faster cognitive decline in Alzheimer’s disease[J]. Eur Radiol, 2017, 27(3): 1169-1175.
[2] HAYS C C, ZLATAR Z Z, CAMPBELL L, et al. Subjective cognitive decline modifies the relationship between cerebral blood flow and memory function in cognitively normal older adults[J]. J Int Neuropsychol Soc, 2018, 24(3): 213-223.
[3] 李建章. 慢性脑缺血的临床诊断与治疗[J]. 中华医学信息导报, 2015, 30(16): 22.
[4] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑血管疾病分类2015[J]. 中华神经科杂志, 2017, 50(3): 168-171.
[5] MEYER I A, CEREDA C W, CORREIA P N, et al. Factors associated with focal computed tomographic perfusion abnormalities in supratentorial transient ischemic attacks[J]. Stroke, 2018, 49(1): 68-75.
[6] KARLSSON L, KANGEFJÄRD E, HERMANSSON S, et al. Risk of recurrent stroke in patients with symptomatic mild (20-49% NASCET) carotid artery stenosis[J]. Eur J Vasc Endovasc Surg, 2016, 52(3): 287-294.
[7] HIRAI S. MRI in patients with cerebral infarct and chronic cerebral circulation insufficiency[J]. No To Shinkei, 1991, 43(9): 811-816.
[8] 章军建, 周书. 慢性脑缺血: 一个独立的疾病实体?[J]. 中华医学杂志, 2012, 92(41): 2881-2884.
[9] ZHOU D, MENG R, LI S J, et al. Advances in chronic cerebral circulation insufficiency[J]. CNS Neurosci Ther, 2018, 24(1): 5-17.
[10] JIA B, SCALZO F, AGBAYANI E, et al. Multimodal CT techniques for cerebrovascular and hemodynamic evaluation of ischemic stroke: occlusion, collaterals, and perfusion[J]. Expert Rev Neurother, 2016, 16(5): 515-525.
[11] HEISS W D. PET imaging in ischemic cerebrovascular disease: current status and future directions[J]. Neurosci Bull, 2014, 30(5): 713-732.
[12] BISDAS S, NEMITZ O, BERDING G, et al. Correlative assessment of cerebral blood flow obtained with perfusion CT and positron emission tomography in symptomatic stenotic carotid disease[J]. Eur Radiol, 2006, 16(10): 2220-2228.
[13] HUANG A P, TSAI J C, KUO L T, et al. Clinical application of perfusion computed tomography in neurosurgery[J]. J Neurosurg, 2014, 120(2): 473-488.
[14] BARON J C, BOUSSER M G, REY A, et al. Reversal of focal "misery-perfusion syndrome" by extra-intracranial arterial bypass in hemodynamic cerebral ischemia. A case study with 15O positron emission tomography[J]. Stroke, 1981, 12(4): 454-459.
[15] 高培毅, 林燕. 脑梗死前期脑局部低灌注的CT灌注成像表现及分期[J]. 中华放射学杂志, 2003, 37(10): 882-886.
[16] HOEFFNER E G, CASE I, JAIN R, et al. Cerebral perfusion CT: technique and clinical applications[J]. Radiology, 2004, 231(3): 632-644.
[17] 高培毅, 林燕, 张红梅. 动态CT脑血流灌注测量及临床初步应用[J]. 中国医学影像技术, 2001, 17(2): 153-135.
[18] DONAHUE J, WINTERMARK M. Perfusion CT and acute stroke imaging: foundations, applications, and literature re-view[J]. J Neuroradiol, 2015, 42(1): 21-29.
[19] LI C, SUN H, ARRICK D M, et al. Chronic nicotine exposure exacerbates transient focal cerebral ischemia-induced brain injury[J]. J Appl Physiol, 2016, 120(3): 328-333.
[20] BENOWITZ N L, BURBANK A D. Cardiovascular toxicity of nicotine: Implications for electronic cigarette use[J]. Trends Cardiovasc Med, 2016, 26(6): 515-523.
[21] SZOŁTYSEK-BOŁDYS I, SOBCZAK A, ZIELIŃSKA-DANCH W, et al. Influence of inhaled nicotine source on arterial stiffness[J]. Przegl Lek, 2014, 71(11): 572-575.
[22] SONG X, ZHU W, AN R, et al. Protective effect of Daming capsule against chronic cerebral ischemia[J]. BMC Complement Altern Med, 2015, 15: 149. |
|
|
|