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目的 应用CT灌注成像观察放射性脑病微循环血流动力学变化及其病理基础 ,进一步推测放射性脑病的可能发病机制。方法 病理证实鼻咽癌 2 0例共 2 6个病灶 ,选 17个病灶对侧颞叶非病变区共 2 2个感兴趣区 (ROI) ,与颞叶病变区ROI灌注结果进行比较。结果 CT灌注图像中显示 2 6个低脑血流量 (CBF)、低脑血液容积 (CBV)病灶 ,同时也显示峰值时间 (TP)图中对比剂到达延迟。其中 2 3个颞叶病变中 ,7个颞叶坏死灶内未见血流灌注。 16个颞叶非坏死病变与 2 2个非病变区颞叶白质比较 ,非坏死病变区CBF下降 ,平均通过时间 (MTT)延长 ,其差异均具有非常显著性意义(t值分别为 7 47,9 38;P值均 <0 0 1)。TP延长不显著 (t=1 78,P >0 0 5 )。 3个桥脑放射性脑病的CBF均较正常均值降低。结论 CBF是反映放射性脑病微循环灌注的直接指标 ,其诊断意义较大。MTT、TP是反映血管阻力的参数 ,对诊断有参考价值。病灶区的微循环障碍是其重要的病理基础 ,其CBF下降 ,提示微循环障碍 ,更进一步支持了放射性脑病的血管损伤学说。
Objective To observe the changes of hemodynamics and pathology of microcirculation of radiation encephalopathy by CT perfusion imaging and to further speculate the possible pathogenesis of radiation encephalopathy. Methods Twenty-two cases of nasopharyngeal carcinoma were confirmed by pathology. Twenty-two regions of interest (ROI) in the contralateral temporal lobe non-lesion region were selected from 17 lesions and compared with the ROI perfusion results of the temporal lobe region. Results There were 26 lesions with low CBF and CBV in the CT perfusion images and the delayed arrival of contrast in the peak time (TP). Twenty-three of the 23 temporal lobe lesions showed no blood perfusion in 7 temporal lobe necrosis lesions. 16 non-necrotic temporal lobe lesions compared with 22 non-diseased area temporal lobe white matter, non-necrotic lesion area CBF decreased mean transit time (MTT), the differences were very significant (t = 7 47, 9 38; all P <0 0 1). TP prolonged insignificantly (t = 1 78, P> 0 0 5). CBF of 3 pontine encephalopathy was lower than the normal mean. Conclusion CBF is a direct indicator of microcirculation perfusion of radiation encephalopathy, its diagnostic significance. MTT, TP is a parameter that reflects vascular resistance, a reference value for diagnosis. Microcirculation of the lesion area is an important pathological basis for its decline in CBF, suggesting microcirculation, and further support for the theory of vascular damage of radiation encephalopathy.