rentradВестник рентгенологии и радиологииJournal of radiology and nuclear medicine0042-46762619-0478Limited Liability Company "LUCHEVAYA DIAGNOSTIKA", Russian Association of Radiologists10.20862/0042-4676-2015-0-2-5-14rentrad-10Research ArticleСтатьиОценка церебральной гемодинамики методом компьютерно-томографической перфузии у пациентов с интракраниальными аневризмамиAssessment of cerebral hemodynamics using computed tomography perfusion in patients with intracranial aneurysmsГригорьеваЕ. В.Grigor'evaE. V.

к. м. н., врач-рентгенолог

MD, PhD, Radiologist

КрыловВ. В.KrylovV. V.

д. м. н., профессор, академик РАН, руководитель отдела нейрохирургии

MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences,Chief of Department of Neurosurgery

Лечебно-диагностический центр «ПАТЕРО КЛИНИК»РоссияMedical and Diagnostic Center «PATERO KLINIK»Russian FederationГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского»РоссияN.V. Sklifosovskiy Research Institute of Emergency CareRussian Federation20152702201602514Copyright © Григорьева Е.В., Крылов В.В., 20162016Григорьева Е.В., Крылов В.В.Grigor'eva E.V., Krylov V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.russianradiology.ru/jour/article/view/10

Цель исследования – определить влияние аневризм интракраниальных артерий на состояние коллатерального кровотока головного мозга и оценить зависимость этих изменений от размеров и локализации аневризмы.

Материал и методы

Материал и методы. Компьютерно-томографическая (КТ) перфузия и КТ-ангиография проведены 41 пациенту с 47 интракраниальными аневризмами без разрыва, различной локализации и размеров.

Результаты

Результаты. У большинства пациентов с интракраниальными аневризмами диаметром менее 15 мм нарушения перфузии выявлены не были. У 70% пациентов с аневризмами размером 16–25 мм отмечена гипоперфузия в соответствующих височной и затылочной долях. У 100% пациентов с аневризмами размером более 25 мм диагностирована распространенная гипоперфузия, причем частично тромбированные аневризмы сопровождались более глубоким, необратимым дефицитом непосредственно вокруг аневризматического мешка, вызванным эффектом объемного воздействия, тогда как при наличии нетромбированной аневризмы гипоперфузия в некоторых случаях охватывала кору всего полушария. Распространенность и глубина гипоперфузии в данном исследовании зависели не от локализации аневризмы, а от ее размера и степени тромбированности просвета.

Заключение

Заключение. Использование КТ-перфузии может быть рекомендовано для включения в стандарт обследования пациентов с выявленной интракраниальной аневризмой размером 16 мм и более для своевременной диагностики нарушений микроциркуляции коры и недостаточности коллатерального кровотока, что может повлиять на выбор метода лечения пациента.

 

 

Objective

Objective: to determine the impact of aneurysm of intracranial arteries on cerebral collateral circulation and to assess the relationship between these changes and the site of the aneurysm.

Material and methods

Material and methods. CT perfusion and CT angiography were performed in 41 patients with 47 unruptured intracranial aneurysms of different sites and sizes.

Results

Results. Impaired perfusion was not found in the majority of the patients with intracranial aneurysms less than 15 mm in diameter. Hypoperfusion in the respective temporal and occipital lobes was noted in 70% of  patients with aneurysms greater than 16–25 mm. Generalized hypoperfusion was diagnosed in 100% of patients with aneurysms more than 25 mm, with the partially thrombosed aneurysms accompanied by the severer, irreversible deficit immediately around the aneurysmal sac, which was induced by the effect of volumetric exposure while in the presence of unthrombosed aneurysm, hypoperfusion occasionally involved the cortex of the entire hemisphere. In this investigation, the extent and depth of hypoperfusion depended on the thrombosis of the lumen and the size of an aneurysm rather than the site of the latter.

компьютерная томографияперфузияаневризмагемодинамикаангиографияcomputed tomographyperfusionaneurysmhemodynamicsangiographyReferencesKornienko V.N., Pronin I.N. Diagnostic neuroradiology. Moscow: Meditsinskaya literatura; 2008 (in Russian).Kornienko V.N., Pronin I.N. Diagnostic neuroradiology. Moscow: Meditsinskaya literatura; 2008 (in Russian).Krylov V.V., Godkov I.M. Brain aneurysm surgery. Moscow: Novoe vremya; 2011; 1: 23–35 (in Russian). 3. Trufanov G.E., Rameshvili T.E., Fokin V.A., Svistov D.V. Imaging of vascular malformations and intracranial aneurysms. St. Petersburg: ELBI-SPb; 2006 (in Russian).Krylov V.V., Godkov I.M. Brain aneurysm surgery. Moscow: Novoe vremya; 2011; 1: 23–35 (in Russian). 3. Trufanov G.E., Rameshvili T.E., Fokin V.A., Svistov D.V. Imaging of vascular malformations and intracranial aneurysms. St. Petersburg: ELBI-SPb; 2006 (in Russian).Krylov V.V., Godkov I.M. Hemodynamic factors of formation, growth and rupture of brain aneurysms. Nevrologicheskiy zhurnal. 2011; 1: 4–9 (in Russian).Krylov V.V., Godkov I.M. Hemodynamic factors of formation, growth and rupture of brain aneurysms. Nevrologicheskiy zhurnal. 2011; 1: 4–9 (in Russian).Grigor'eva E.V., Godkov I.M., Polunina N.A., Krylov V.V. The features of cerebral aneurysms hemodynamics. Neyrokhirurgiya. 2013; 3: 76–9 (in Russian).Grigor'eva E.V., Godkov I.M., Polunina N.A., Krylov V.V. The features of cerebral aneurysms hemodynamics. Neyrokhirurgiya. 2013; 3: 76–9 (in Russian).Wintermark M., Sesay M., Barbier E. et al. Comparative overview of brain perfusion imaging techniques. Stroke. 2005; 36: 83–99.Wintermark M., Sesay M., Barbier E. et al. Comparative overview of brain perfusion imaging techniques. Stroke. 2005; 36: 83–99.Cebral J.R., Mut F., Weir J., Putman C.M. Association of hemodynamic characteristics and cerebral aneurysm rupture. Am. J. Neurorad. 2011; 32: 264–70.Cebral J.R., Mut F., Weir J., Putman C.M. Association of hemodynamic characteristics and cerebral aneurysm rupture. Am. J. Neurorad. 2011; 32: 264–70.Sforza D.M., Putman Ch.M., Cebral J.R. Hemodynamics of cerebral aneurisms. Ann. Rev. Fluid Mech. 2009; 4: 91–107.Sforza D.M., Putman Ch.M., Cebral J.R. Hemodynamics of cerebral aneurisms. Ann. Rev. Fluid Mech. 2009; 4: 91–107.Herzig R., Bogousslavsky J., Maeder P., Maeder-Ingvar M., Reichhart M., Urbano L.A., Leemann B. Intracranial arterial and arteriovenous malformations presenting with infarction. Lausanne Stroke Registry Study. Eur. J. Neurol. 2005; 12: 93–102.Herzig R., Bogousslavsky J., Maeder P., Maeder-Ingvar M., Reichhart M., Urbano L.A., Leemann B. Intracranial arterial and arteriovenous malformations presenting with infarction. Lausanne Stroke Registry Study. Eur. J. Neurol. 2005; 12: 93–102.Chupakhin A.P., Cherevko A.A. et al. Measurement and analysis of local cerebral hemodynamics in patients with vascular malformations of the brain. Patologiya krovoobrashcheniya i kardiokhirurgiya. 2012; 4: 27–31 (in Russian).Chupakhin A.P., Cherevko A.A. et al. Measurement and analysis of local cerebral hemodynamics in patients with vascular malformations of the brain. Patologiya krovoobrashcheniya i kardiokhirurgiya. 2012; 4: 27–31 (in Russian).Krylov V.V., Lemenev V.L., Murashko A.A., Luk'yanchikov V.A., Dalibaldyan V.A. The treatment of patients with atherosclerotic damage of brachiocephalic arteries combined with intracranial aneurysms. Neyrokhirurgiya. 2013; 2: 80–5 (in Russian).Krylov V.V., Lemenev V.L., Murashko A.A., Luk'yanchikov V.A., Dalibaldyan V.A. The treatment of patients with atherosclerotic damage of brachiocephalic arteries combined with intracranial aneurysms. Neyrokhirurgiya. 2013; 2: 80–5 (in Russian).Krylov V.V., Klimov A. B., Polunina N.A. The diagnostics and treatment of patients with giant intracranial aneurysms. Neyrokhirurgiya. 2010; 3: 14–24 (in Russian).Krylov V.V., Klimov A. B., Polunina N.A. The diagnostics and treatment of patients with giant intracranial aneurysms. Neyrokhirurgiya. 2010; 3: 14–24 (in Russian).Tateshima S., Tanishita K., Omura H., Villablanca J.P., Vinuela F. Intraaneurysmal hemodynamics during the growth of an unruptured aneurysm: in vitro study using longitudinal CT angiogram database. Am. J. Neuroradiol. 2007; 28: 622–7.Tateshima S., Tanishita K., Omura H., Villablanca J.P., Vinuela F. Intraaneurysmal hemodynamics during the growth of an unruptured aneurysm: in vitro study using longitudinal CT angiogram database. Am. J. Neuroradiol. 2007; 28: 622–7.Cebral J.R., Castro M.A., Burgess J.E., Pergolizzi R., Putman C.M. Characterization of cerebral aneurysm for assessing risk of rupture using patient-specific computational hemodynamics models. Am. J. Neurorad. 2005; 26: 2550–9.Cebral J.R., Castro M.A., Burgess J.E., Pergolizzi R., Putman C.M. Characterization of cerebral aneurysm for assessing risk of rupture using patient-specific computational hemodynamics models. Am. J. Neurorad. 2005; 26: 2550–9.Krylov V.V., Nakhabin O.Yu., Polunina N.A., Luk'yanchikov V.A., inokurov A.S., Kuksova N.S. et al. The first experience of high-flow extra-intracranial bypass for treatment of patients with giant aneurysms of the internal carotid artery. Neyrokhirurgiya. 2013; 2: 25–39 (in Russian).Krylov V.V., Nakhabin O.Yu., Polunina N.A., Luk'yanchikov V.A., inokurov A.S., Kuksova N.S. et al. The first experience of high-flow extra-intracranial bypass for treatment of patients with giant aneurysms of the internal carotid artery. Neyrokhirurgiya. 2013; 2: 25–39 (in Russian).Nakhabin O.Yu., Luk'yanchikov V.A., Krylov V.V. The technique of extraintracranial high-flow bypass performance for treatment of patients with giant carotid aneurysms. Neyrokhirurgiya. 2012; 4: 57–65 (in Russian).Nakhabin O.Yu., Luk'yanchikov V.A., Krylov V.V. The technique of extraintracranial high-flow bypass performance for treatment of patients with giant carotid aneurysms. Neyrokhirurgiya. 2012; 4: 57–65 (in Russian).Hoeffner E.G., Case I., Kain R., Gujar S.K., Shah G.V., Deveikis J.P. et al. Cerebral perfusion CT: technique and clinical applications. Radiology. 2004; 231: 632–44.Hoeffner E.G., Case I., Kain R., Gujar S.K., Shah G.V., Deveikis J.P. et al. Cerebral perfusion CT: technique and clinical applications. Radiology. 2004; 231: 632–44.Mills J.N., Mehta V., Russin J., Amar A.P., Rajamohan A., Mack W.J. Advanced imaging modalities in the detection of cerebral vasospasm. Neurol. Research Intern. 2013; 2013: 415960: 1–15.Mills J.N., Mehta V., Russin J., Amar A.P., Rajamohan A., Mack W.J. Advanced imaging modalities in the detection of cerebral vasospasm. Neurol. Research Intern. 2013; 2013: 415960: 1–15.

The authors declare that there are no conflicts of interest present.