| Part one:The study of cerebral circulation time and whole brain perfusion hemodynamics in normal adultsObjective:1.Measure healthy people cerebral circulation time (CCT)with640slice dynamic volume CT, and the relevant research of CCT with age, gender and side.2.Measure cerebral perfusion parameters such as cerebral blood flow(CBF), cerebral blood volume(CBV),mean transit time(MTT), time to peak(TTP) with640slice dynamic volume CT, and the relevant research between these cerebral perfusion parameters and age,analyze the blood perfusion characteristics of the different parts of brain parenchyma.Materials and Methods45healthy people volunteers(23men,22women; age range15～60years old, mean age39.2±12.1years old) were included in this study. All of the subjects were divided into three groups by age:15-20years old for the youth group(5pepoles),21-40years old for junior group(22pepoles),41-60years old for the middle-aged group(18peoples). All of the subjects had pass the head CT scan or MR examination showed normal before do the head CTA examination, previously had no cardiovascular disease, hypertension, diabetes, hyperlipidemia, the nervous system examination was normal.Using Aquilion ONE640slice dynamic volume CT, detector width is160mm, one revolution can cover the whole brain, the shortest time of completing a scan is0.35second. Using dual-drum high pressure syringes, Contrast agent using non-ionic contrast agent Ultravist (370mgI/ml). Enhanced scan contrast agent dose50ml, and injection of20ml saline, above injection speed are5ml/s.All patients supine position, scan range is set to160mm,first perform the head plain scan(tube voltage120kv, tube current200m As), after injection of contrast agent detention8s start the volume scan,8～17s continuous volume scanning,18s-33s interval3s scan once,35s-60s interval5s, The entire scan duration60s.Entire scanning volume were twenty-two data packets.Measurement of cerebral circulation time:All volume data of the patient have been put into brain analysis packages to perform image post-processing. Remove the bone by4D-DSA to get4D-CTA image and then multiplanar reconstruction.0.1square millimeter of ROI were placed in cross rock bone segment of the bilateral carotid artery and sigmoid sinus area. Measure the CT values of each phase. Record the time when the increase of the CT value is more than double of the standard deviation which means the time of developing.Time difference between contrast agent reached the sigmoid sinus and internal carotid artery petrous bone segment was defined as CCT.Measure cerebral perfusion parameters:all volume data of the patient have been put into Vitrea FX work station and brain analysis packages to perform image post-processing.The4D-Perfusion software automatically input artery (middle cerebral artery) and output vein (the superior sagittal sinus).Calculate the time density curve of the region of interest (ROI).Use the deconvolution algorithm to get perfusion parameters such as CBF, CBV, MTTand TTP.Two imaging diagnosis physician selected blinded evaluation on the CTP and4D-CTA images of all medical case of illness, when they reached agreement in identify the whole brain perfusion area, measured in the axial perfusion maps, ROI selection of0.1cm2.Symmetry measure perfusion parameters such as frontal lobe, parietal lobe,occipital lobe,temporal lobe white matter and gray matter,basal ganglia (lenticular nucleus, caudate nucleus), every parameters measured3times, average regions of interest and mirror area. Measurement should try to avoid vascular, recording the average value of the measured values obtained from the two physicians, Semi-quantitative analysis of the images and parameters.All data(including CCT,CBF, CBV, MTT, TTP)showed asx±.All statistical processing using SPSS13.0statistical analysis package, inspection level0.05,when P<0.05the differences were considered statistical significance.Using paired T test to compare the CCT of the left and right sides, take the average value of the left and right sides of the cerebral arteriovenous circulation time.Using two independent samples t test to compare the differences between genders.Using One-Way ANOVA analysis CCT differences among different age groups.Using two independent samples t test to compare gender difference in CBF, CBV, TTP and MTT.Using Factorial information designed two-way ANOVA to compare different parts and age groups difference in CBF, CBV, TTP and MTT. Using LSD and Dunnett’s T3as multiple comparisons.Using pearson analysis correlation among age in CBF, CBV, TTP and MTT.Result1.Normal people group have no statistical significance in CCT difference among different side,gender and age.2.Compare the perfusion parameters the different sides, gender, the diffrence have no statistical significance.The perfusion parameters in different parts of normal people are different. The interaction effects of all combinations on different parts and age groups have different perfusion parameters, the diffrence have no statistical significance.3.We find that different ages have different perfusion parameters, the difference have statistical significance. The difference of perfusion parameters of youth group and junior group, junior group and middle-aged group have no statistical significance.4.The perfusion parameters of different parts and age in accordance with normal distribution.Using Pearson correlation analysis, it showed that age is negatively correlated with CBF and CBV, positively correlated with MTT and TTP.Conclusion1.640slice dynamic volume CT can be used to determine cerebral circulation time. The cerebral circulation time of normal people have no correlation with side, age and gender.2.The cerebral perfusion parameters of the Symmetric parts of the left and right side are basically the same.There was difference in basal ganglia area, gray matter area, white matter area of the normal people’s cerebral perfusion parameters.The basal ganglia area of blood perfusion is the highest and the white matter area is the lowest.3.The cerebral perfusion parameters of the different age are different.When the age growth the CBF and CBV gradually reduce, and the MTT and TTP gradually extended. Part two:Research of perihematom tissue in cerebral arteriovenous malformation with dynamic CT perfusion imgingPurpose1. The feasibility of measurement CCT of the CAVM by640slice volume CT.2. Measure the change of cerebral microcirculation which around the CAVM by640slice dynamic volume CT. Research the correlational between the abnormal perfusion around the CAVM and the classification of the Spetzler arteriovenous.Materials and MethodsChoose the CAVM patients who were treated in neurosurgery of the Dongkuan Kanghua Hospital from May2012to February2013as study objects. None of the pathological changes get treatment. All of the patients were researched by640slice dynamic volume cerebral CT perfusion. There were20males and15females, average age30.9±13.7years old,the range of age was7to63years old, The35cases of CAVM were divided to Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴ,Ⅵ by Spetzler arteriovenous classification method.The cases of each classification were2,5,18,6,4,0. All cases were confirmed by pathology or DSA.Equipment and CTP scanning methods are the same as the first part, all patients were performed whole brain CT perfusion scanning scheme and method of measurement CCT was as the same as the first part.Cerebral perfusion parameter measurement:according to TDC measurement perfusion parameters, such as first part.In axial of brain enhancement image sketch out the scope of CAVM respectively.Vitrea FX automatic trace out the scope of CAVM, placed0.1cm2areas of gray matter, white matter, measurement of perfusion parameters. Each parameters measured three times.Express the CCT,CBF,CBV,MTT and TTP value as x±s.Statistical analysis by SPSS13.0software package,inspection level0.05,when P<0.05the differences were considered statistical significance.. Measured CCT by DSA and640slice volume CT and compare the difference of them with two independent samples t-test. Compare the difference of CCT which measured from the AVM group and the control group by two independent samples t-test.Divide the CAVM into three groups such as Ⅰ～Ⅱ,Ⅲ and IV-V.Compare the gray and white matter of the I-II/III/IV-V CAVM with the perfusion parameters of the control group by One-Way-ANOVA. Multiple comparisons by LSD or Dunnett’s T3.Inspection level was0.05.When the value of P is less than0.05the difference means statistically significance.Analyze the corelation between the perfusion parameters and the Spetzler arteriovenous classification by Spearman relevance analysis. When the value of P was less than0.05the difference means statistically significance.Result1.The comparsion CAVM group with control group of CCT, the difference is statistically significant;the comparsion640slice volume CT group with DSA group of CCT, the difference was statistically significant.2. The comparsion Ⅰ～Ⅱ CAVM group with the contol group of perfusion parameters of gray matter, white matter, the differences between CBF, MTT of white matter and gray matter was statistically significant, the differences between CBV, TTP of white matter and gray matter was no statistically significant.The comparsion Ⅲ CAVM group with the control group of perfusion parameters of gray matter, white matter,all of the differences were statistically significant. The comparsion Ⅵ～Ⅴ CAVM group with the control group of perfusion parameters of gray matter, white matter,all of the differences were statistically significant.3. In the around of CAVM were low perfusion. Different grades of cAVM two comparisons,the compasion of cAVM perfusion parameters, respectively, all of the difference were statistical significance/the compasion.4. The CBF and CBV were negative correlation between grades, correlation coefficient is-0.829and-0.528; The MTT and TTP were positive correlation between grades, correlation coefficient is0.732and0.643.Conclusion1.There is no significant difference between the DSA and the cerebral circulation time which measured by640layer CT. The CCT of the CAVM group is significantly shorter than the control group.2. Varying degrees of hypoperfusion area exist around the CAVM.When the level of the CAVM is more higher,the degree of stolen blood is more serious. Part three:Clinical analysis of risk factors of cerebral arteriovenous malformations with hemorrhagic presentationPurposeInvestigate the risk factors of CAVM rupture and hemorrhage to reasonable prediction of the clinical to the patient who has CAVM with hemorrhagic, Scientific guidance the treatment and prognostic evaluation of CAVM, Reduce the morbidity and mortality of CAVM hemorrhage.Materials and Methods106patients who were hospitalized in Dongguan Kanghua Hospital to cure CAVM from January1,2009to March1,2013were collected by retrospective analysis method. Among them there were60men and46women,age6-63,average age30.5±13.1.74cases of CAVM rupture accounting for69.8%of all patients.32cases of CAVM admitted to hospital without hemorrhage accounting for30.2%.Clinical Factors:age,sex and related clinical factors of CAVM hemorrhage.Angioarchitecture relevant factors:get the CAVM accurate image features by preoperative brain3D-CTA to observe the relevant factors about CAVM such as position/size/the type and number of feeding arteries/venous drainage way/the number of draining veins/combined blood flow aneurysm and draining vein stenosis of the vascular malformation group.Deal with all the data by SPSS13.0statistics software. The measurement data were expressed as mean±standard deviation (x±SD) and the enumeration data expressed as percentage.Univariate analysis:Analyze the pertinency among the clinical and angioarchitecture factors with CAVM hemorrhage by chi-square test.Compare two group level data by non-parametric test of two independent samples. Compare multi-group level data by non-parametric test of multi-group independent samples and choose the inspection level as0.05.There is statistic difference in the incidence of hemorrhage between exposed and control group when the bilateral P<0.05.Multiple factors logistie regression analysis:Use the multivariate Logistic regression model analysis when the univariate analysis have statistically significance and choose the inspection level as0.05. Take the factors as the independent risk factor of AVM hemorrhage when P<0.05and OR>1.Result1.Univariate analysis①Age and sex:there was no statistically significance between different genders and ages with AVM hemorrhage rate.②The location of the CAVM:There is statistically significance in the difference of the deep and superficial CAVM hemorrhage.The risk of deep CAVM hemorrhage is higher than the superficial CAVM hemorrhage.③The size of the CAVM:The size of the CAVM is divided into three levels in accordance with the maximum diameter of the vascular malformation group. Less than3cm for small;3to6cm for medium-sized; large than6cm for large. There is statistically significance in the difference of the size.The risk of the CAVM hemorrhage which the size is less than3cm is higher.④The feeding artery of the CAVM:The feeding artery of the CAVM is divided into superficial, deep and mixed blood supply according to the location of the CAVM. There is no statistically significance among the difference of the3groups.Divid the feeding artery of the CAVM into I ramus,2to3ramus and more than3ramus according to the number of the CAVM. There is no statistically significance among the difference of the3groups.⑤The venous drainage of the CAVM:The venous drainage of the CAVM is divided into superficial, deep and drainage mixed venous drainage of the CAVM. There is no statistically significance among the difference of the three groups. The risk of the deep venous drainage hemorrhage is higher. Divid the venous drainage of the CAVM into1ramus,2to3ramus and more than3ramus according to the number of the venous drainage. The risk of1ramus venous drainage hemorrhage is the largest.⑥The CAVM merger-related aneurysm:The CAVM is divided into merger-related aneurysm and unconsolidated aneurysm. There is statistically significance in the difference of the two groups. The risk of merger-related aneurysm hemorrhage is significantly higher.⑦The CAVM merger drainage vein stenosis:The CAVM is divided into merger drainage vein stenosis and no stenosis. There is no statistically significance in the difference of the two groups.2. Multivariate logistic regression analysisUse the multivariate Logistic regression model analysis when the univariate analysis have statistically significance. Use the Forward LR stepwise regression and choose the inspection level a=0,05.The final result is that there is statistically significance in deep CAVM, small less than3cm AVM, deep venous drainage and single venous drainage.But the difference of the merger blood flow aneurysm have no statistically significance.Conclusion1. Univariate analysis showed that there is no correlation among the Gender, age, type of artery, the number of artery, draining vein stenosis with the cerebral arteriovenous malformation hemorrhage.2. Multivariate logistic regression analysis.The CAVM which locate in deep brain,small,single venous drainage,deep venous drainage is likely to rupture hemorrhage as the independent risk factors. |
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