| Objective: Using the computerized tomography perfusion imaging (CTPI) conbined with computerized tomography angiography(CTA) to observe the changes of regional cerebral blood flow and blood-supply artery, to study the value of CTPI and CTA in the clinical diagnosis of vertebrobasilar insufficiency(VBI).And then further exploring the etiological factors and pathophysiological mechanism of VBI .Methods: 50 patients with VBI, which clinical symptoms displayed mainly dizziness was enrolled into the study randomly, 20 healthy peoples without VBI symptoms and CTA negative were enrolled as controlled group. All patients were diagnosed VBI according to the revised classification for cerebrovascular disease in the 1995 National Conference.Exclusive criteria: (1) cerebral hemorrhage, Intracalvarium infection, tumor and infarction corresponding to clinical symptoms by undergoing CT or MRI;(2) acoustic nerve tumor and Meniere disease, labyrinthitis;(3)bleeding disease and angiostaxis, cardia insufficiency, severe hepatopathy and nephropathy, hyperthyroidism or hypothyroidism;(4)be allergic to iodine.Two groups were underwent CTA and CTPI.Correlated parameters were recorded.Results:1.39(78%)of 50 patients with VBI were revealed abnormal perfusion regions corresponding to clinical symptom in CTPI, of which there were 39 cases revealed abnormal perfusion regions on mean transmit time (MTT) maps, and 29 cases on cerebral blood flow(CBF) maps, only 10 on cerebral blood volume(CBV) maps. Other 11 cases showed normal results in CTPI.2.In 50 cases with VBI, the MTT of affected side (4.6±1.3)s compared with that of the contralateral side (3.9±0.9)s was significantly prolonged (P<0.05); Also, the CBF of affected side (36.4±13.26)ml/(100g·min) compared with that of the contralateral side (43.2±14.95)ml/(100g·min) was significantly different (P<0.05); And the difference of the CBV (P>0.05) was not statistically significant between the affected side (1.9±0.7)ml/100g and the contralateral side(2.0±0.6) ml/100 g.3.The average△MTT of the patient group(0.74±0.65)s compared with that of the controlled group(0.08±0.07)s was significantly different (t=6.26 , P<0.05); The average△CBF of the patients group(6.83±5.31)ml/100g·min compared with that of the controlled group(0.47±0.45)ml/100g·min was significantly different (t=7.42 , P<0.05); The difference of theΔCBV (t=1.0,P>0.05) was not statistically significant between the patients group(0.24±0.23)ml/100g and the controlled group (0.17±0.25)ml/100g.4.In 50 cases checked by CTA, there were 40 cases (80%) with abnormal vascular. Among them 34 cases(85%) were revealed perfusion abnormalities, which were matched with clinical symptoms. There were 5 cases (50%) with perfusion abnormalities but without convict vascular. Through statistical analysis, there was a significant difference between them.5.The correspondence relationship between CTPI and CTA abnormality had the following 4 types: (1)There were 34 cases (68%) with perfusion abnormalities accompanied by abnormal vascular supplying the abnormal perfusion region (convict vascular). Among them, 23 cases had vascular stenosis, 9 cases had vertebral artery dysplasia, 2 cases showed circuitous vertebral artery. (2)There were 5 cases (10%) with perfusion abnormalities in CTPI but without abnormal vascular in CTA. (3)There were 6 cases (12%) with convict vascular in CTA but without perfusion abnormalities in CTPI. (4)There were 5 cases (10%) neither had abnormal vascular nor had perfusion abnormalities.Conclusions:1.MTT is the most sensitive and primary indicator in the diagnosis of VBI, the changes of CBF and CBV can reveal the various pathophysiological state of VBI.2.The hypoperfusion is the pathophysiological base of VBI, and the vertebrobasilar stenosis is the etiological factor of VBI.3.CTPI combined with CTA is important to study the etiology of VBI, and provides the direct and objective support for the diagnosis of VBI.
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