Clinical Value Of One Stop CT Perfusion Imaging In Cerebrovascular Diseases

PART ONE CT perfusion imaging for quantitative evaluation of surgical treatment of moyamoya disease follow-up study【Objective】Objective to investigate the changes of cerebral perfusion after superficial temporal artery middle cerebral artery bypass grafting(STA-MCA)in patients with moyamoya disease,and to evaluate the surgical effect.【Materials and methods】Retrospective analysis of 31 patients(44 cerebral hemispheres)(male: female = 20:11,mean age: 33 years)of clinically diagnosed moyamoya disease and parallel STA-MCA operation.There were 13 cases of bilateral bypass surgery and 18 cases of unilateral bypass.All patients underwent NCCT-CTA-CTP examination before and after operation.The perfusion parameters of CTP(CBF,CBV,MTT,TTP,delay TTP)were obtained by post-processing.The regions of interest were placed in the white matter and cerebral cortex(middle cerebral artery blood supply area)from basal ganglia level to the central half oval level respectively.The perfusion parameters of CTP before and after operation were compared and measured,and took the average value.The data of 35 groups were measured as long-term point(NCCT-CTA-CTP examination time range was 3 months to 3 years).The ratio of CTP perfusion parameters before and after operation was calculated,and the changes of CTP perfusion parameters and clinical indexes before and after operation were quantitatively analyzed.【Results】By CTP quantitative follow-up analysis,it was found that the perfusion value of cerebral cortex was similar to that of white matter,TTP and delay TTP were significantly decreased(P ≤ 0.024).After operation,the CBV value of white matter decreased from 2.74 ± 0.90 ml / 100 mg before operation to 2.38 ± 0.67 ml / 100 mg after operation(P < 0.001).The MTT value decreased slightly(P = 0.022).The CBF value also showed a significant downward trend,but the change was not statistically significant.MTT,CBF and CBV of cerebral cortex also changed slightly after operation,but there was no statistical significance.Based on the literature and previous studies,we tried to find the time threshold of cerebral perfusion changes after surgery.It was found that cerebral perfusion decreased to the lowest level in 6-8 months,and returned to the preoperative level in about 1 year.【Conclusion】CTP can evaluate the changes of brain,bypass vessels and cerebral perfusion in patients with moyamoya disease after bypass surgery.During the follow-up,with the extension of bypass time,brain perfusion decreased to the lowest level in 6-8 months,and returned to the preoperative level in about 1 year;In the long run,the level of cerebral perfusion after bypass surgery is similar to that before surgery.PART TWO Explore the Value of CT Perfusion in Predicting the Prognosis of Patients with Acute Cerebral Infarction【Objective】Analysis of CT perfusion imaging(CTP)and clinical data before and after treatment in acute ischemia stroke(AIS)patients,and to identify the prognostic related imaging and clinical features.【Methods】Prospectively included 39 CT/MRI confirmed AIS patients(Male: Female = 21:18,mean age: 65 years,mean onset time: 8.4h),and they were followed for 90 days to obtain their m RS score(mean 2.8).All patients underwent 320-row spiral CTP scan,and non-contrast CT(NCCT),CT angiography(CTA)and CT perfusion(CTP)were generated.ASPECTS score and CTP perfusion parameters(CBF,CBV,MTT,TTP,Delay-TTP)was calculated.In addition,the volume of cerebral ischemia core,ischemic penumbra and their ratio were obtained.Three ROIs with similar size were placed in the cerebral infarction core,ischemic penumbra and corresponding contralateral brain parenchyma,and all the parameters were measured three times respectively,and to take the average value.【Results】Of 39 AIS patients,20 patients showed good prognosis(m RS≤2).Correlation analysis showed that NIHSS score,ischemia core volume,MTT and delayed-TTP in ischemic penumbra were significantly positively correlated with m RS scores at 90days(P≤0.04).While the post-treatment ASPECTS and CBF in the ischemia core were significantly negatively correlated with m RS scores at 90days(P< 0.05).Further comparative analysis demonstrated that NIHSS score before and after treatment,ASPECTS after treatment and ischemia core volume and CBF in ischemia core were significantly different in AIS patients with good or bad prognosis(P≤0.03).ROC analysis showed that NIHSS score had the highest diagnostic value in predicting the prognosis of AIS patients(AUC: 0.90),and the sensitivity,specificity and cut-off values were 79%,85% and 4.5,respectively.CBF in the ischemia core had the best specificity(89%)and the post-treatment ASPECTS demonstrated the highest sensitivity(94%)in prognosis predicting of AIS patients.【Conclusion】Ischemia core volume,CBF,NIHSS score before and after treatment and post-treatment ASPECTS of AIS patients were closely related with their prognosis.Compared with NIHSS score,the ischemia core CBF has a higher specificity in predicting the prognosis of AIS patients.