| Objective:The characteristics of CT cerebral perfusion in patients with different Willis ring morphologies were studied,and the differences in perfusion parameters in different variations of Willis loop morphology in cerebral infarction group and control group were discussed.Methods:From December 2016 to December 2017,a total brain volume imaging and head and neck CT angiography examination were performed in 170 patients with dizziness and headache in the fourth affiliated hospital of the medical university of China,and the mri DWI was performed within 48 hours.The patients were grouped according to the results of the examination,and the infarcts were infarcted and the control group was not infarcted.The two groups of data were used for multi-dimensional display of the head and carotid artery by using VR,MIP and MPR,and the Willis ring of the two groups was selected as the study object to evaluate the integrity and different variation of Willis.Packaged application workstation Perfusion Perfusion analysis,get the cerebral blood flow(CBF),cerebral blood volume(CBV),mean through time(determined by MTT),tmax(TTP),whole brain Perfusion parameters,such as in patients with infarction group,records left and right side of the brain arteries(ACA)blood supply area,middle cerebral artery(MCA)and posterior cerebral artery(PCA)blood supply area,ACA/MCA border area(before watershed area),MCA/PCA border area(such as watershed area)after area infarcts number,Measured lesion area and ROI image area of CBF,CBV,determined by MTT,TTP perfusion parameters,such as,for without the control of infarction,the cerebellum,basal ganglia,lateral ventricle body level and parietal lobe level for typical level,measure and record the typical level of relative perfusion parameters on both sides of the hemisphere.SPSS22.0 package for statistical analysis,measurement data with independent sample t-test to compare between two groups,first using the single factor analysis of variance between groups,F inspection,the comparison of differences between groups,and then the method of LSD,place of pair-wise comparison between groups,P<0.05 statistically significant.Results:(1)infarction group 120 cases(70.59%),of which 69 cases(40.59%)after traffic artery is absent,contains the traffic deficiency such as 10 cases(5.88%)of the left side,right after the traffic deficiency such as 12 cases(7.06%),double lientang 47 cases(27.65%),the traffic is absent embryonal posterior cerebral artery of 32 cases(18.82%),contains the type on the left side of the embryo posterior cerebral artery in 5 patients(2.94%),on the right side of embryonal posterior cerebral artery in 7 cases(4.12%),20 cases of bilateral embryonal posterior cerebral artery(11.76%).There were 11 cases(6.47%)of the anterior cerebral artery,including 4 cases(2.35%)in the left A1 segment,7 cases(4.12%)in the right A1 segment,and 9 cases(5.29%)in the Willis ring.Control group of 50 cases(29.41%),of which the traffic artery is absent after 30 cases(17.65%),included 2 cases(1.18%),on the right side is absent on the left side of the lack of such as 3 cases(1.76%),25 cases(14.71%),double side is absent embryonal 14 cases(8.24%),posterior cerebral artery contains left in 2 cases(1.18%),4 cases(2.35%)on the right side,double side 8 cases(4.71%),the A1 section of the anterior cerebral artery is absent in 3 patients(1.76%),contains the right 1 case(0.59%),on the left side of the 2 cases(1.18%),Complete 3 cases of Willis ring(1.76%).Infarction group and the control group on the incidence of the A1 segment of the anterior cerebral artery as statistically significant differences(2 ?19.601,P = 0.045<0.01).(2)in the traffic artery is absent,the control of CBF,CBV and infarction group of infarction area of CBF,CBV comparison,the difference was statistically significant(t = 6.939,P = 0.000<0.05,t = 3.988,P = 0.000<0.05),the control group of determined by MTT,TTP and infarction group not infarction area determined by MTT,TTP comparison,the difference was statistically significant(t ?4.11,P = 4.11<0.05,t = 4.16,P = 0.05<0.05).(3)in the traffic artery is absent,the control group and not rCBF of infarction area of infarction group,the rCBV,rMTT,there were no statistically significant differences between rTTP(t = 8.383,P ?0.835>0.05,t = 4.992,P = 0.136>0.05,t = 3.8,P = 0.774>0.05,t = 6.63,P ?0.133>0.05).(4)embryonal posterior cerebral artery,the control of CBF compared with infarction group not CBF infarction area,the difference was statistically significant(t = 7.979,P = 0.001<0.05),the control group of CBV,determined by MTT,TTP compared with infarction group of infarction area,there were no statistically significant difference(t = 2.013,P = 0.177>0.05,t = 0.033,P = 0.976>0.05,t = 1.595,P = 0.138>0.05).(5)embryonal posterior cerebral artery,the control group and not rCBF of infarction area of infarction group,the rCBV,rMTT,there were no statistically significant differences between rTTP(t = 6.361,P = 0.369>0.05,t = 1.693,P = 0.693>0.05,t = 0.556,P = 0.562>0.05,t = 1.689,P = 0.098>0.05).(6)the A1 is absent,the anterior cerebral artery in the control group compared with infarction group not CBF infarction area,CBF was statistically significant difference(t = 6.040,P = 0.012<0.05),the control of CBV,determined by MTT,TTP compared with infarction group of infarction area,there were no statistically significant difference(t = 1.358,P = 0.295>0.05,t = 1.929,P = 0.145>0.05,t = 1.808,P ?0.100>0.05).(7)the A1 is absent,the anterior cerebral artery and infarction control group of infarction area of rCBF,rCBV,rMTT,there were no statistically significant differences between rTTP(t = 8.369,P = 0.896>0.05,t = 1.653,P = 0.398>0.05,t ?2.363,P = 0.096>0.05,t = 2.893,P = 0.136>0.05).(8)when Willis ring complete control of CBF compared with infarction group not CBF infarction area,the difference was statistically significant(t = 3.014,P = 0.015<0.05),the control of CBV,determined by MTT,TTP compared with infarction group of infarction area,there were no statistically significant difference(t = 0.307,P = 0.774>0.05,t = 2.142,P = 0.131>0.05,t = 1.825,P = 0.123>0.05).(9)when the Willis ring was complete,there was no significant difference in rCBF,rCBV,rMTT and rTTP between the control group and the infarcted group(t=4.053,P=0.365>0.05,t=-0.129,P=0.732>0.05,t=-3.562,P=0.366>0.05,t=-1.356,P=0.569 BBB 3 0.05).(10)in the infarction group,double lientang traffic artery is absent,rCBF of between groups,rCBV,rMTT,rTTP respectively with F test,single factor variance analysis differences had no statistical significance between groups(F = 0.953,P = 0.440>0.05,F = 1.155,P = 0.339>0.05,F = 0.942,P = 0.446>0.05,F = 0.625,P = 0.646>0.05),and then two comparison with LSD method,There was no statistically significant difference in rCBF,rCBV,rMTT and rTTP between basal ganglia,thalamus,pontoon,temporal lobe,and multiple hair(P BBB 0.05).(11)in the infarction group,embryonal posterior cerebral artery,on both sides of rCBF,rCBV,between multiple sets of rMTT respectively with F test,single factor variance analysis differences had no statistical significance between groups(F = 1.937,P = 0.147>0.05,F = 0.260,P = 0.854>0.05,F = 0.638,P = 0.597>0.05),but rTTP comparison between groups,the difference was statistically significant(F = 2.960,P = 0.049<0.05),with LSD pairwise comparison,Pons part rCBF and basal ganglia area of cerebral infarction cerebral infarction of rCBF comparison,the difference was statistically significant(P = 0.038<0.05),basal ganglia infarction and pons infarction,thalamus infarction and pons infarction,multiple infarction and pons infarction between rTTP comparison,the difference had statistical significance(P = 0.006<0.05,P = 0.012<0.012,P = 0.043<0.05).(12)in the infarction group,the A1 is absent,the anterior cerebral artery of rCBF,rCBV,rTTP comparison between groups,no statistically significant difference between group(F = 0.357,P = 0.710>0.05,F = 0.151,P = 0.862>0.05,F = 1.834,P=0.215>0.05),but rMTT comparison between groups,the difference was statistically significant(F = 5.948,P = 0.023<0.05),with LSD pairwise comparison,There were statistically significant differences in rMTT between basal ganglia infarction and multiple infarction,cerebral bridge infarction and multiple infarction(P=0.026<0.05,P=0.011<0.05).(13)in the infarction group,complete,Willis ring between the multiple sets of rCBF,rCBV,rMTT,rTTP comparison of differences between groups were statistically significant(F = 3.652.P = 0.042<0.05,F = 5.203,P = 0.05<0.05,F = 5.383,P = 0.05<0.05,F = 5.048,P = 0.05<0.05),reoccupy LSD pairwise comparison,rCBF of basal ganglia infarction with frontal lobe infarction,rCBV,rMTT,rTTP comparison,The differences were statistically significant(P=0.035<0.05,P=0.031<0.05,P=0.037<0.05,P=0.037<0.05),and the differences were statistically significant(P=0.031<0.05,P =0.029<0.05,P=0.019<0.05).(14)in the control group,rCBF and rCBV,rTTP comparison between groups,there was no statistically significant difference between the groups(F = 0.527,P = 0.350>0.05,F = 0.751,P = 0.426>0.05,F = 3.567,P = 0.466>0.05),but rMTT was statistically significant difference between the groups(F = 3.339,P = 0.036<0.05),and then using LSD pairwise comparison,There was a statistical significance(P=0.041<0.05)for the absence of anterior cerebral artery A1,such as the complete rMTT of the Willis ring.(15)in the control group,there was no statistically significant difference in rCBF,rCBV,rMTT and rTTP between unilateral and bilateral arterial arteries(t=3.263,P=0.536>0.05,t=4.635,P=0.096>0.05,t=-3.256,P=0.876>,0.05,t=-2.369,P=0.432>0.05).(16)in the control group,there was no statistically significant difference in rCBF,rCBV,rMTT and rTTP in the unilateral and bilateral arterial arteries(t=5.269,P=0.865>0.05,t=2.369,P=0.317>0.05,t=-4.551,P=0.451>0.05,t=-3.651,P=0.087>0.05).(17)in the infarction group,located in the basal ganglia infarction,multiple sets of rCBF,rCBV,rMTT,rTTP comparison between differences had no statistical significance between groups(F = 0.184,P =0.832>0.05,F = 0.390,P = 0.679>0.05,F = 1.136,P = 0.329>0.05,F = 0.915,P =0.407>0.05),with LSD pairwise comparison,rCBF,rCBV,rMTT,rTTP differences had no statistical significance(P>0.05).(18)in the infarction group,located in the pons infarction,rCBF and rCBV,rMTT comparison between groups,no statistically significant difference between group(F = 1.642,P = 0.234>0.05,F = 0.610,P ?0.560>0.05,F = 0.187,P = 0.831>0.05),but rTTP was statistically significant difference between the groups(F = 2.139,P = 0.040<0.05),and two with LSD method comparison,The difference in the rTTP between the two sides of the posterior cerebral artery and the anterior cerebral artery after the bilateral fetal brain was statistically significant(P=0.026<0.05,P=0.011<0.05).(19)in the infarction group,is located in the thalamus infarction,rCBV,rTTP comparison between groups,no statistically significant difference between group(F = 0.186,P = 0.834>0.05,F =0.116,P = 0.892>0.05),but was statistically significant difference between rCBF,rMTT groups(F = 29.31,P = 0.000<0.05,F = 4.116,P = 0.05<0.05),with LSD method are compared,and two Double lientang traffic artery is absent and double side embryonal posterior cerebral artery,the A1 is absent and the anterior cerebral artery after bilateral embryonic brain rCBF difference had statistical significance(P = 0.003<0.05,P = 0.000<0.05),the A1 segment of the anterior cerebral artery with bilateral embryonal posterior cerebral artery rMTT difference was statistically significant(P =0.022<0.05).(20)in the infarction group,multiple infarction area,between multiple sets of rCBF,rCBV,rMTT,rTTP comparison,there was no statistically significant difference between the groups(F = 1,139,P = 0.341>0.05,F = 1.190,P = 0.326>0.05,F = 0.367,P = 0.697>0.05,F = 0.404,P = 0.673>0.05),reoccupy LSD pairwise comparison,rCBF,rCBV,rMTT,rTTP differences were no statistical significance(P>0.05(21)infarction group,After unilateral traffic artery is absent,the ipsilateral basal ganglia infarction and in bilateral basal ganglia infarction between rCBF,rCBV,rMTT,rTTP comparison,there was no statistically significant difference(t = 6.398,P = 0.725>0.05,t = 3.221,P = 0.089>0.05,t = 3.653,P = 0.531>0.05,t=1.225,P = 0.214>0.05).(22)infarction group,after unilateral traffic artery is absent,the ipsilateral pons infarction and the dorsal pons infarction between rCBF,rCBV,rMTT,rTTP comparison,differences were statistically significant(t = 5.398,P?0.025<0.05,t = 4.221,P = 0.05<0.05,t = 4.5223 P = 0.05<0.05,t = 3.114,P ?0.05<0.05).Conclusion:(1)PCoA is important for blood flow compensation in the infarcted area of the cerebral infarction.(2)after bilateral embryonal brain arteries,compared with in other parts of the infarcts,pons infarction relative peak for a long time,may indicate bilateral embryonal pons area when the posterior cerebral artery blood flow;(3)after unilateral,traffic artery is absent in rCBF,rCBV pons infarction ipsilateral lower than occurs in the contralateral,rMTT,rTTP is higher than those in the contralateral,prompted the traffic artery blood supply possible regulatory role of pons area. |
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