The Application Of CT Cerebral Perfusion Imaging In Evaluating Cerebral Hemodynamics Result From ASAH

Objective To research the application value of the dual-source CT brain volume perfusion imaging (CTP) in the aneurysmal subarachnoid hemorrhage (aSAH), and the cerebral blood flow after aSAH by brain CTP, and investigate the value of4D-CTA in the diagnosis of aSAH.Methods12cases of aSAH negative and49cases of aSAH patients were checked using Siemens dual-source CT, and in which of12aSAH patients underwent aneurysm clipping postoperative CTP review. First conventional head plain, then use the "cradle-bed" technology CTP scan, scan range11.4cm, covering most of the brain tissue. The original image was processed by the SIMENS workstation Neuro CTP software getting the perfusion curve and the pseudo-color pictures. Measuring cerebral blood flow (CBF) of the cerebral cortex, white matter and basal ganglia, cerebral blood volume (CBV), time to peak (TTP) and mean transit time (MTT) of aSAH negative and aSAH patients respectively; measuring CBF, CBV, TTP and MTT of abnormal perfusion areas and contralateral mirror regions of interest of aSAH patients respectively; measuring CBF, CBV, TTP and MTT of cerebral cortex, white matter and basal ganglia of12aSAH patients before aneurysm surgery and postoperative respectively; Compared the difference of abnormal perfusion parameters between the aSAH negative and aSAH patients, the SAH group abnormal perfusion areas and the contralateral mirror regions of interest, the12aSAH patients aneurysm surgery before and after. Using the original data through the post-processing CTP get4D-CTA image for the diagnosis of aneurysm, and compared the4D-CTA results with DSA and surgical results.Results49patients, six of which failed to carry out CTP after treatment because of head movement.43aSAH patients with various parts of the perfusion parameters compared with the aSAH negative, there were significant difference of the CBF, CBV and MTT of aSAH patients with white matter (P<0.01) and basal ganglia (P<0.05);26patients found51low perfusion areas, there were significant differences of CBF, CBV, TTP, MTT of low perfusion and contralateral mirror area (P<0.01); CBV and MTT of abnormal perfusion areas of aneurysm surgery and postoperative were significantly different (P<0.05). Hunt-Hess and Fisher were in negative correlation with CBF, but positive correlation with CBV and MTT. Compared with DSA and surgical results, the positive rate of aneurysms with4D-CTA was92.54%.Conclusion1. Dual-source CT cradle bed CTP technology can get more cerebral blood flow dynamics information of aSAH patients;2. After SAH, CVS got the most impact on the white matter, followed by basal ganglia; CTP can determine the range of cerebral ischemia and ischemic extent; In the perfusion parameters, MTT is the most sensitive indicator of vasospasm after SAH. TTP is expected to CVS-induced ischemia-sensitive indicators after SAH, and combined with the CBF and CBV, which will be better evaluation of cerebral blood flow perfusion.3. CTP scan, which gets the4D-CTA image with more accurate scanning time window, better low artifact interference characteristics, can be used for aSAH etiological diagnosis.