[1]廖廷泉　苏祖禄　石　会.CT灌注成像预测及诊断蛛网膜下腔出血后迟发性脑缺血的Meta分析[J].中国临床神经外科杂志,2018,(07):458-462.[doi:10.13798/j.issn.1009-153X.2018.07.004]
　LIAO Ting-quan,SU Zu-lu,SHI Hui..Value of CT perfusion imaging to prediction and diagnosis of delayed cerebral ischemia after subarachnoid hemorrhage: a meta-analysis[J].,2018,(07):458-462.[doi:10.13798/j.issn.1009-153X.2018.07.004]
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CT灌注成像预测及诊断蛛网膜下腔出血后迟发性脑缺血的Meta分析()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2018年07期
页码:
458-462
栏目:
论著
出版日期:
2018-07-25

文章信息/Info

Title:
Value of CT perfusion imaging to prediction and diagnosis of delayed cerebral ischemia after subarachnoid hemorrhage: a meta-analysis
文章编号:
1009-153X（2018）07-0458-05
作者:
廖廷泉　苏祖禄　石　会
作者单位：402160 重庆，重庆医科大学附属永川医院神经外科（廖廷泉、苏祖禄、石　会）
Author(s):
LIAO Ting-quan;  SU Zu-lu;  SHI Hui.
Department of Neurousurgery, Affiliated Yongchuan Hospital, Chongqing Medical Univeicity, Chongqing 632100, China
关键词:
蛛网膜下腔出血; 迟发性脑出血; CT灌注成像; 诊断; 预测; Meta分析
Keywords:
Subarachnoid hemorrhage;  CT perfusion imaging;  Delayed cerebral ischemia;  Meta-analysis
分类号:
R 743.9
DOI:
10.13798/j.issn.1009-153X.2018.07.004
文献标志码:
A
摘要:
目的 系统评价CT灌注成像（CTP）对蛛网膜下腔出血（SAH）后迟发性脑缺血（DCI）的诊断及预测价值。方法 计算机检索PubMed、Cochrane Database、Embase、CNKI及中国生物医学文献库中有关CTP与DCI关系的研究。使用Rev Man 5.3软件进行Meta分析。结果 共纳入10篇文献，包括519例SAH。Meta分析结果显示，SAH早期CTP的CBF、CBV、MTT、TTP与DCI无明显相关性（P>0.05）。高发时间窗内CTP的CBF降低、MTT增高与DCI有关（P<0.05），而CBV、TTP与DCI无显著相关性（P>0.05）。对DCI的诊断界值，CBF在25~36.3 ml/100g/min范围内变化，而MTT则在5.0~6.5 s范围内变化。结论 CTP可用于诊断而不能用于早期预测SAH后DCI，但仍需标准化CTP测量方法及确定DCI的最佳诊断界值。
Abstract:
Objective To evaluate the value of CT perfusion imaging (CTP) to the prediction and diagnosis of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH). Methods The databases including PubMed, Cocharane Database of systematic Rviews , Embase, CNKI and SinoMed were searched for studies of the value of CTP to the prediction and diagnosis of DCI after SAH. A meta-analysis was performed by software RevMan (version 5.3). Results A total of 10 studies including 519 patients with SAH were involved. The meta-analysis showed that there were insignificant differences in cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time-to-peak (TTP) between the patients with and without DCI after SAH. In the DCI time-window CBF was significantly lower in the patients with DCI than that in the patients without DCI after SAH (MD=-12.75 ml/100g/min, 95%CI:-15.85~-9.65) and MTT was significantly higher in the patients with DCI than that in the patients without DCI after SAH (MD=1.44s, 95%CI:1.16~-1.72). Conclusions CTP can be used to diagnose but not to predict DCI after SAH. There are necessary to standardize the method to measure the cerebral perfusion with CTP after SAH and optimize and validate perfusion thresholds of DCI diagnosis after SAH.

参考文献/References:

[1] Dankbaar JW, Rijsdijk M, van der Schaaf IC, et al. Rela- tionship between vasospasm, cerebral perfusion, and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage [J]. Neuroradiology, 2009, 51(12): 813-819.
[2] Dankbaar JW, de Rooij NK, Rijsdijk M, et al. Diagnostic threshold values of cerebral perfusion easured with com- puted tomography for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage [J]. Stroke, 2010, 41: 1927-1932.
[3] Rijsdijk M, van der Schaaf IC, Velthuis BK, et al. Global and focal cerebral perfusion after aneurysmal subarachnoid hemorrhage in relation with delayed cerebral ischemia [J]. Neuroradiology, 2008, 50(9): 813-820.
[4] van der Schaaf I, Wermer MJ, Vand GY, et al. CT after subarachnoid hemorrhage: relation of cerebral perfusion to delayed cerebral ischemia [J]. Neurology, 2006, 66(10): 1533-1538.
[5] 季卫阳，王　中，鲁晓杰，等. CT灌注成像在蛛网膜下腔 出血后脑血管痉挛诊断中的应用[J]. 江苏医药，2011，37 （4）：427-429.
[6] Lagares A, Cicuendez M, Ramos A, et al. Acute perfusion changes after spontaneous SAH: a perfusion CT study [J]. Acta Neurochir (Wien), 2012, 154(3): 405-412.
[7] Rodriguez-Régent C, Hafsa M, Turc G, et al. Early quanti- tative CT perfusion parameters variation for prediction of delayed cerebral ischemia following aneurysmal subarach- noid hemorrhage [J]. Eur Radiol, 2015, 26(9): 1-8.
[8] Chai WN, Sun XC, Lv FJ, et al. Clinical study of changes of cerebral microcirculation in cerebral vasospasm after SAH [J]. Acta Neurochir Suppl, 2011, 110(Pt 1): 225-228.
[9] Killeen RP, Mushlin AI, Johnson CE, et al. Comparison of CT perfusion and digital subtraction angiography in the evaluation of delayed cerebral ischemia [J]. Acad Radiol, 2011, 18(9): 1094-1100.
[10] Sanelli PC, Anumula N, Johnson CE, et al. Evaluating CT perfusion using outcome measures of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage [J]. Am J Neuroradiol, 2013, 34(2): 292-298.
[11] Sviri GE, Britz GW, Lewis DH, et al. Dynamic perfusion computed tomography in the diagnosis of cerebral vaso- spasm [J]. Neurosurgery, 2006, 59(2): 319-325.
[12] Etminan N, Beseoglu K, Heiroth HJ, et al. Early perfusion computerized tomography imaging as a radiographic surro- gate for delayed cerebral ischemia and functional outcome after subarachnoid hemorrhage [J]. Stroke, 2013, 44(5): 1260-1266.
[13] Vergouwen MD, Vermeulen M, Coert BA, et al. Microthrom- bosis after aneurysmal subarachnoid hemorrhage: an addi- tional explanation for delayed cerebral ischemia [J]. J Cereb Blood Flow Metab, 2008, 28(11): 1761-1770.
[14] Dreier J P, Woitzik J, Fabricius M, et al. Delayed ischaemic neurological deficits after subarachnoid haemorrhage are associated with clusters of spreading depolarizations [J]. Brain, 2006, 129(12): 3224-3237.
[15] Kanazawa R, Kato M, Ishikawa K, et al. Convenience of the computed tomography perfusion method for cerebral vaso- spasm detection after subaraehnoid hemorrhage [J]. Surg Neurol, 2007, 67(6): 604-611.

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备注/Memo

备注/Memo:
通讯作者：苏祖禄，E-mail：417435001@qq.com
更新日期/Last Update: 2018-07-25