目的探讨CT灌注成像(CTP)对 烟雾病脑血管重建术后患者血流动力学 改变的评价效果。方法 选择在本院行 脑血管重建术治疗的30例烟病雾患者作 为研究对象，并使用多层螺旋CT对其行 脑灌注成像扫描，观察患者的术前术后 CTP图像表现，分析其脑缺血区域术前术 后相对脑血流量(rCBF)、相对脑血容量 (rCBV)、达峰时间(TTP)、平均通过时 间(MTT)及延迟时间(DLY)变化情况。结 果 30例患者中有9例存在脑出血症状， 21例存在脑缺血症状，经影像检查发现 单发或多发软化灶20例，出血灶10例， 共有颈内动脉末段不同程度狭窄53支， 其中大脑前动脉狭窄18例，大脑中动脉 21例，大脑后动脉14例，且均有异常侧 支循环形成；而其中有行双侧颅骨多点 钻孔间接血流重建术治疗7例，行单侧直 接血流重建术治疗23例；30例患者经CTP 检查发现异常灌注区41处，而术前异常 灌注区与双侧相对正常区比较，rCBV、 rCBF明显减低，TTP、MTT及DLY则明显 延长，且存在明显差异(P＜0.05)；术 后异常灌注区与双侧相对正常区rCBV、 rCBF与术前比较则明显升高，TTP、MTT 及DLY则明显缩短，但rCBV、rCBF、 TTP、MTT与术前比较无明显差异(P＞ 0.05)，而DLY与术前比较存在明显差 异(P＜0.05)；术后异常灌注区与双侧 相对正常区比较，rCBV、rCBF仍明显 减低，TTP、MTT及DLY则仍明显延长(P ＜0.05)。结论 CTP可有效为术前烟雾病 检查提供脑血流灌注信息，显示患者血 管狭窄、闭塞及异常情况，同时还可明 显显示血管重建术治疗期间患者脑血流 灌注改变情况，对评估血管重建术后烟 雾病患者动力学改变具有重要意义。

Objective To evaluate the effect of CT perfusion imaging (CTP) on hemodynamics in patients with moyamoya disease after cerebral revascularization. Methods 30 patients with moyamoya disease treated by cerebral vascular reconstruction in our hospital were selected as the subjects and the brain perfusion imaging was performed by multislice spiral CT. The CTP images of the patients were observed before and after operation, and the cerebral blood flow (rCBF) and relative cerebral blood volume were analyzed before and after the operation in the cerebral ischemia area. (rCBV), peak time (TTP), average passage time (MTT) and delay time (DLY). Results Of the 30 patients, 9 had cerebral hemorrhage symptoms, 21 cases had cerebral ischemia symptoms, 20 cases of single or multiple softening were found by imaging examination, 10 cases of hemorrhagic foci, 53 stenosis of different degree of internal carotid artery, including 18 cases of anterior cerebral artery stenosis, 21 cases of middle cerebral artery, 14cases of posterior cerebral artery, and abnormal collateral circulation. There were 7cases of bilateral cranial multi point drilling indirect blood flow reconstruction, and 23 cases were treated by direct blood flow reconstruction. 41 of abnormal perfusion areas were found by CTP examination in 30 patients, while the preoperative abnormal perfusion area was compared with that of bilateral normal areas, and rCBV and rCBF were significantly reduced, TTP, MTT and DLY were obviously prolonged. The comparison of rCBV and rCBF in abnormal perfusion area and bilateral relative normal area was significantly higher, and TTP, MTT and DLY were significantly shorter, but there was a significant difference between TTP, MTT and DLY (P<0.05). MTT and DLY were still prolonged. Conclusion CTP can provide cerebral blood flow information for the preoperation of moyamoya disease, which shows the stenosis, occlusion and abnormal condition of the patients. It can also show the changes of cerebral blood flow in the patients during the revascularization, which is of great significance for evaluating the dynamic changes of the patients with moyamoya disease after revascularization.