切换至 "中华医学电子期刊资源库"
高级检索
中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2023, Vol. 20 ›› Issue (10) : 1046 -1055. doi: 10.3877/cma.j.issn.1672-6448.2023.10.008

头颈部超声影像学

单侧颈内动脉闭塞患者行颞浅动脉-大脑中动脉搭桥术的脑血流动力学评估
魏淑婕, 惠品晶†(), 丁亚芳, 张白, 颜燕红, 周鹏, 黄亚波   
  1. 215006　苏州大学附属第一医院神经外科-颈脑血管超声科
    215006　苏州大学附属第一医院神经外科
  • 收稿日期:2022-11-04 出版日期:2023-10-01
  • 通信作者: 惠品晶
  • 基金资助:
    苏州市民生科技项目(SS202061); 苏州大学技术开发合作项目(H211064)

Evaluation of cerebral hemodynamics in patients with unilateral internal carotid artery occlusion undergoing superficial temporal artery-middle cerebral artery bypass

Shujie Wei, Pinjing Hui†(), Yafang Ding, Bai Zhang, Yanhong Yan, Peng Zhou, Yabo Huang   

  1. Department of Neurosurgery Carotid and Cerebrovascular Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
    Department of Neurosurgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
  • Received:2022-11-04 Published:2023-10-01
  • Corresponding author: Pinjing Hui
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

魏淑婕, 惠品晶, 丁亚芳, 张白, 颜燕红, 周鹏, 黄亚波. 单侧颈内动脉闭塞患者行颞浅动脉-大脑中动脉搭桥术的脑血流动力学评估[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1046-1055.

Shujie Wei, Pinjing Hui, Yafang Ding, Bai Zhang, Yanhong Yan, Peng Zhou, Yabo Huang. Evaluation of cerebral hemodynamics in patients with unilateral internal carotid artery occlusion undergoing superficial temporal artery-middle cerebral artery bypass[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1046-1055.

目的

应用经颅多普勒超声（TCD）及CT灌注成像（CTP）评估单侧颈内动脉闭塞患者行颞浅动脉-大脑中动脉搭桥（STA-MCA bypass）术前后的脑血流动力学变化。

方法

回顾性连续纳入2016年1月至2021年5月于苏州大学附属第一医院神经外科因慢性单侧颈内动脉闭塞行STA-MCA bypass术的患者85例。根据美国介入和治疗神经放射学学会/介入放射学学会（ASITN/SIR）标准将患者分为A组65例（ASITN/SIR 0~2级）和B组20例（ASITN/SIR 3级）。运用经颅多普勒（TCD）评估患者STA-MCA bypass术前后的双侧大脑中动脉（MCA）远段（检测深度30~40 cm）平均血流速度（Vm）、收缩期峰值血流速度（Vs）、舒张期末血流速度（Vd）、血管搏动指数（PI）。评估患者双侧基底节及颞叶CTP参数，计算脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）及达峰时间（TTP），并计算患侧/健侧CTP（rCTP）。采用美国国立卫生研究院卒中量表（NIHSS）评估患者神经系统评分。采用Spearman秩相关分析患侧MCA远段Vm与NHISS评分的相关性。

结果

TCD参数：术前及术后A、B两组的患侧MCA远段的Vm、Vs、Vd以及PI均低于健侧（P均<0.05）。术前A组患侧Vm、Vs、Vd以及PI均低于B组，2组患者术后的Vm、Vs、Vd以及PI均高于术前，差异均有统计学意义（P均<0.05）；术后2组间的Vm、Vs、Vd以及PI比较差异无统计学意义（P均>0.05）。rCTP参数：术前A组rCBF和rCBV均低于B组（P均<0.05），rMTT及rTTP均大于B组（P均<0.05）；2组术后的rCBF均高于术前，rMTT、rTTP均低于术前（P均<0.05），B组术后的rCBV低于术前（P均<0.05），A组术后颞叶rCBV较术前升高（P<0.05），基底节rCBV与术前相比差异无统计学意义（P>0.05）。NHISS评分：A组患者术前及术后NHISS评分均高于B组，差异均有统计学意义（P均<0.05）；2组患者术后NHISS评分均低于术前，差异均有统计学意义（P均<0.05）。A、B两组患者术前MCA Vm与NHISS评分呈负相关（r=-0.659、-0.626，P均<0.01），而术后MCA Vm与NHISS评分不存在线性相关关系。

结论

STA-MCA bypass术后，脑灌注得到明显改善。TCD及CTP有助于评估STA-MCA bypass围手术期的脑血流动力学改变，TCD是临床无创评估及随访脑血流动力学的有效工具。

关键词: 超声检查，多普勒，经颅, CT灌注成像, 颈内动脉闭塞, 颞浅动脉-大脑中动脉搭桥术, 血流动力学, 侧支循环
Objective

To evaluate cerebral hemodynamics before and after unilateral internal carotid artery occlusion in patients undergoing superficial temporal artery-middle cerebral artery bypass (STA-MCA bypass) by transcranial Doppler ultrasound (TCD) and CT perfusion imaging (CTP).

Methods

Eighty-five patients who underwent STA-MCA bypass grafting for unilateral internal carotid artery occlusion at the Neurosurgery Department of the First Affiliated Hospital of Soochow University from January 2016 to May 2021 were retrospectively enrolled. According to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) criteria, the patients were divided into group A (65 cases; ASITN/SIR Grade 0-2) and group B (20 cases; ASITN/SIR Grade 3). The average blood flow velocity (Vm), peak systolic blood flow velocity (Vs), end-diastolic blood flow velocity (Vd), and vascular pulse index (PI) of the bilateral middle cerebral arteries (MCA) in the distal section (detection depth 30~40 cm) were evaluated by TCD before and after STA-MCA bypass. CTP parameters of the bilateral basal ganglia and temporal lobes were evaluated to calculate cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and peak time (TTP), as well as CTP of the affected side/healthy side (rCTP). The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the neurological score. Spearman rank correlation was used to analyze the correlation between the Vm of the MCA distal segment and NHISS score.

Results

The Vm, Vs, Vd, and PI of the MCA distal segment on the affected side were lower than those on the healthy side in both groups A and B before and after surgery (P<0.05 for all). Preoperative Vm, Vs, Vd, and PI of the affected side in group A were lower than those in group B, and postoperative Vm, Vs, Vd, and PI of the two groups were significantly higher than those before surgery (P<0.05 for all). There were no significant differences in Vm, Vs, Vd, or PI between the two groups after surgery (P>0.05 for all). Before operation, rCBF and rCBV in group A were lower than those in group B, and rMTT and rTTP were higher than those in group B (P<0.05 for all). rCBF after operation was higher than that before operation, while rMTT and rTTP were lower than those before operation (P<0.05 for all).The postoperative rCBV of group B was lower than that before surgery (P<0.05), the postoperative rCBV of the temporal lobes in group A was higher than that before surgery (P<0.05), and the rCBV of the basal ganglia was not significantly different from that before surgery (P>0.05). Preoperative and postoperative NHISS scores in group A were significantly higher than those in group B, (P<0.05 for both). The NHISS scores of the two groups were significantly lower after surgery than before surgery (P<0.05 for both). There was a negative correlation between MCA Vm and NHISS score in both groups before surgery (r=-0.659, P<0.01; r=-0.626, P<0.01), while there was no linear correlation between MCA Vm and NHISS score after surgery.

Conclusion

After STA-MCA bypass surgery, cerebral perfusion is significantly improved. TCD and CTP are helpful to evaluate the perioperative cerebral hemodynamics of STA-MCA bypass, and TCD is an effective tool for non-invasive clinical evaluation and follow-up of cerebral hemodynamics.

Key words: Ultrasonography, Doppler, transcranial, CT perfusion imaging, Internal carotid artery occlusion, Superficial temporal artery-middle cerebral artery bypass, Hemodynamics, Collateral circulation
表1 2组单侧颈内动脉闭塞患者基线资料比较
资料 A组（n=65） B组（n=20） 统计值 P值
男性[例（%）] 48（74） 14（70） χ2=0.115 0.735
年龄（岁，） 59.63±9.16 55.10±10.10 t=1.888 0.063
高血压病[例（%）] 40（62） 12（60） χ2=0.015 0.902
血脂异常[例（%）] 26（40） 10（50） χ2=0.626 0.429
LDL-C（mmol/L，） 2.01±0.78 1.96±0.60 t=0.258 0.797
HDL-C（mmol/L，） 0.97±0.19 1.00±0.22 t=-0.715 0.477
TC（mmol/L，） 3.58±0.86 3.64±1.09 t=-0.283 0.778
TG（mmol/L，） 1.51±0.86 1.30±0.52 t=1.010 0.315
糖尿病[例（%）] 32（49） 8（40） χ2=0.523 0.470
空腹血糖（mmol/L，） 5.80±1.16 5.94±1.28 t=-0.464 0.644
hs-CRP[mg/L，M（P25，P75）] 7.12（1.74，12.84） 4.79（0.81，12.53） Z=-0.959 0.337
冠心病[例（%）] 13（65） 5（25） χ2=0.229 0.632
吸烟史[例（%）] 18（28） 5（25） χ2=0.056 0.813
左侧颈内动脉闭塞[例（%）] 24（37） 8（40） χ2=0.062 0.804
表2 2组单侧颈内动脉闭塞患者术前患侧MCA远段TCD参数比较（）
组别 例数 Vm（cm/s） Vs（cm/s）
患侧 健侧 t值 P值 患侧 健侧 t值 P值
A组 65 34.40±9.32 68.51±20.77 -12.23 <0.001 48.48±13.36 108.06±32.52 -13.90 <0.001
B组 20 44.15±12.11** 62.75±17.72 -3.86 0.001 63.10±16.81** 100.65±31.19 -4.57 <0.001
组别 例数 Vd（cm/s） PI
患侧 健侧 t值 P值 患侧 健侧 t值 P值
A组 65 27.22±7.40 48.14±14.34 -10.72 <0.001 0.62±0.10 0.87±0.15 -12.85 <0.001
B组 20 33.45±9.22** 43.35±12.33 -3.20 0.004 0.68±0.12* 0.89±0.20 -4.33 <0.001
表3 2组单侧颈内动脉闭塞患者术前与术后患侧MCA远段TCD参数比较（）
组别 例数 Vm（cm/s） Vs（cm/s）
术前 术后 t值 P值 术前 术后 t值 P值
A组 65 34.40±9.32 62.11±26.61 -8.79 <0.001 48.48±13.36 95.66±41.20 -9.46 <0.001
B组 20 44.15±12.11** 57.90±16.99 -3.45 0.003 63.10±16.81** 87.20±26.56 -3.47 0.003
组别 例数 Vd（cm/s） PI
术前 术后 t值 P值 术前 术后 t值 P值
A组 65 27.22±7.40 44.94±19.92 -7.54 <0.001 0.62±0.10 0.82±0.18 -8.64 <0.001
B组 20 33.45±9.22** 41.60±13.88 -2.52 0.021 0.68±0.12* 0.86±0.28 -2.20 0.040
表4 2组单侧颈内动脉闭塞患者rCTP参数比较（）
组别 例数 基底节rCTP参数
rCBF rCBV rMTT rTTP
术前 术后 术前 术后 术前 术后 术前 术后
A组 65 0.80±0.17 0.88±0.14** 0.92±0.19 0.91±0.19 1.43±0.36 1.22±0.23** 1.39±0.19 1.20±0.27**
B组 20 0.90±0.12 0.95±0.14* 1.15±0.15 0.94±0.17** 1.26±0.19 1.13±0.15* 1.24±0.23 1.10±0.09*
t值 -2.48 -1.19 -4.83 -0.673 2.03 1.62 3.02 1.62
P值 0.011 0.059 <0.001 0.526 0.046 0.110 0.004 0.110
组别 例数 颞叶rCTP参数
rCBF rCBV rMTT rTTP
术前 术后 术前 术后 术前 术后 术前 术后
A组 65 0.74±0.12 0.81±0.13** 0.83±0.15 0.88±0.16* 1.57±0.43 1.31±0.24** 1.40±0.18 1.22±0.13**
B组 20 0.81±0.11 0.87±0.11* 1.18±0.19 0.88±0.15** 1.36±0.27 1.25±0.14** 1.26±0.09 1.18±0.10**
t值 -2.20 -1.48 -8.03 0.11 2.04 1.05 3.35 1.16
P值 0.031 0.143 <0.001 0.914 0.044 0.299 0.001 0.248
图1 患者，女，56岁，因左上肢无力逐渐加重1个月余入院，NHISS评分为7分。图a为数字减影血管造影（DSA）示右侧颈内动脉闭塞（白色箭头所示）；图b为DSA示ASTIN/SIR 1级，仅有少量的代偿血流；图c为经颅多普勒超声（TCD）示术前患侧大脑中动脉（MCA）远段呈达峰时间延迟的“低速低搏动” 代偿血流频谱；图d为TCD示术后患侧MCA血流速及阻力指数升高，频谱形态相对正常；图e~h为CT灌注成像（CTP）示该患者术前患侧大脑半球感兴趣区相较于健侧脑血流量、脑血容量减低，平均通过时间、达峰时间延长；图i~l为CTP示该患者术后患侧大脑半球感兴趣区血流灌注情况较术前好转
图2 患者，男，53岁，因反复头晕3个月余入院，NHISS评分为3分。图a为数字减影血管造影（DSA）示右侧颈内动脉闭塞（白色箭头所示）；图b为DSA示ASTIN/SIR 3级，相对完全的代偿血流；图c为经颅多普勒超声（TCD）示术前患侧大脑中动脉（MCA）远段呈相对达峰时间延迟的低速代偿血流频谱；图d为TCD示术后患侧MCA血流速及阻力指数升高，频谱形态正常；图e~h为CT灌注成像（CTP）示该患者术前脑血流量减低，脑血容量升高，平均通过时间及达峰时间延长；图i~l为CTP示该患者术后患侧大脑半球感兴趣区血流灌注情况较术前好转
表5 2组单侧颈内动脉闭塞患者NHISS评分比较[M（P25，P75）]
组别 例数 术前NHISS评分 术后NHISS评分
A组 65 4（3，6） 3（2，4）**
B组 20 2.5（1，3） 1（0，2）**
Z值 3.41 2.73
P值 0.001 0.006
图3 单侧颈内动脉闭塞患者的患侧MCA远段Vm与NHISS评分的相关性分析。图a，b为术前A、B两组患侧MCA远段Vm与NHISS评分的相关性分析散点图；图c，d为术后2组患侧MCA远段Vm与NHISS评分的相关性分析散点图 注：MCA为大脑中动脉；Vm为平均血流速度；A组为ASITN/SIR 0~2级；B组为ASITN/SIR 3级
1
Kaszczewski P, Elwertowski M, Leszczyński J, et al. Volumetric flow assessment in Doppler ultrasonography in risk stratification of patients with internal carotid stenosis and occlusion [J]. J Clin Med, 2022, 11(3): 531.
2
Lan L, Leng X, Ip V, et al. Sustaining cerebral perfusion in intracranial atherosclerotic stenosis: The roles of antegrade residual flow and leptomeningeal collateral flow [J]. J Cereb Blood Flow Metab, 2020, 40(1): 126-134.
3
Myrcha P, Gloviczki P. A systematic review of endovascular treatment for chronic total occlusion of the internal carotid artery [J]. Ann Transl Med, 2021, 9(14): 1203.
4
中国卒中学会脑血流与代谢分会. 缺血性卒中脑侧支循环评估与干预中国指南(2017) [J]. 中华内科杂志, 2017, 56(6): 460-471.
5
Kaszczewski P, Elwertowski M, Leszczyński J, et al. Intracranial flow volume estimation in patients with internal carotid artery occlusion [J]. Diagnostics (Basel), 2022, 12(3): 766.
6
Purkayastha S, Sorond F. Transcranial Doppler ultrasound: technique and application [J]. Semin Neurol, 2012, 32(4): 411-420.
7
Higashida RT, Furlan AJ, Roberts H, et al. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke [J]. Stroke, 2003, 34(8): 109-137.
8
华扬, 惠品晶, 邢瑛琦. 中国脑卒中血管超声检查指导规范 [J/CD]. 中华医学超声杂志(电子版), 2015, 12(8): 599-610.
9
张李均, 惠品晶, 黄亚波, 等. 微型探头血管超声在颞浅动脉-大脑中动脉搭桥术中的应用[J]. 中华神经外科杂志, 2018, 34(9): 915-920.
10
张白, 惠品晶, 颜燕红, 等. 微型探头血管超声在烟雾病患者搭桥术中的血流动力学评估[J/CD]. 中华医学超声杂志(电子版), 2019, 16(9): 676-683.
11
Kasner SE. Clinical interpretation and use of stroke scales [J]. Lancet Neurol, 2006, 5(7): 603-612.
12
Cao G, Hu J, Tian Q, et al. Surgical therapy for chronic internal carotid artery occlusion: a systematic review and meta-analysis [J]. Updates Surg, 2021, 73(6): 2065-2078.
13
Powers WJ, Clarke WR, Grubb RL, Jr., et al. Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial [J]. JAMA, 2011, 306(18): 1983-1992.
14
Ogasawara K, Ogawa A, Yoshimoto T. Cerebrovascular reactivity to acetazolamide and outcome in patients with symptomatic internal carotid or middle cerebral artery occlusion: a xenon-133 single-photon emission computed tomography study [J]. Stroke, 2002, 33(7): 1857–1862..
15
Kataoka H, Miyamoto S, Ogasawara K, et al. Results of prospective cohort study on symptomatic cerebrovascular occlusive disease showing mild hemodynamic compromise [Japanese Extracranial-Intracranial Bypass Trial (JET)-2 Study] [J]. Neurol Med Chir (Tokyo), 2015, 55: 460-468.
16
游潮, 刘翼, 郭睿. 进程崎岖,前途广阔-颅内外血管搭桥术治疗非烟雾病性慢性脑缺血的研究现状及展望 [J]. 中华神经医学杂志, 2021, 20(3): 217-222.
17
Xu Z, Tong Z, Duan Y, et al. Diffusion and susceptibility weighted imaging mismatch correlates with collateral circulation and prognosis after middle cerebral artery M1-segment occlusion [J]. Front Neurol, 2021, 12: 660529.
18
Khan AA, Patel J, Desikan S, et al. Asymptomatic carotid artery stenosis is associated with cerebral hypoperfusion [J]. J Vasc Surg, 2021, 73(5): 1611-1621..
19
Paredes I, Castaño AM, Cepeda S, et al. The effect of cranioplasty on cerebral hemodynamics as measured by perfusion computed tomography and Doppler ultrasonography [J]. J Neurotrauma, 2016, 33(17): 1586-1597.
20
韩佳霖, 惠品晶, 颜燕红, 等. 大脑中动脉慢性闭塞患者脑血流动力学参数与脑梗死体积的相关性研究[J/CD]. 中华医学超声杂志(电子版), 2019, 16(8): 602-608.
21
Kim JH, Yoon W, Kim CK, et al. Efficacy and safety of timely urgent superficial temporal artery-to-middle cerebral artery bypass surgery in patients with acute ischemic stroke: a single-institutional prospective study and a pooled analysis [J]. Cerebrovasc Dis, 2021, 50(1): 34-45.
22
Qiao X, Duan J, Zhang N, et al. Risk factors of impaired perfusion in patients with symptomatic internal carotid artery steno-occlusive disease [J]. Front Neurol, 2022, 13: 801413.
23
杨晨, 董立军, 赵宇, 等. 双源CT全脑灌注成像对大脑中动脉狭窄时侧支循环状态及预后的评估 [J]. 临床放射学杂志, 2018, 37(7): 1072-1077.
24
Seiler A, Kammerer S, Gühl A, et al. Revascularization of high-grade carotid stenosis restores global cerebral energy metabolism [J]. Stroke, 2019, 50(7): 1742-1750.
25
颜燕红, 惠品晶, 惠国桢, 等. 经颅多普勒联合CT灌注成像对单侧颈内动脉重度狭窄或闭塞患者脑血流动力学评价[J]. 中华神经外科杂志, 2013, (6): 603-607.
26
Ospel JM, Brown S, Kappelhof M, et al. Comparing the prognostic impact of age and baseline national institutes of health stroke scale in acute stroke due to large vessel occlusion [J]. Stroke, 2021, 52(9): 2839-2845.
27
赵新宇, 华扬, 高明杰, 等. 颈内动脉闭塞患者侧支循环类型与大脑中动脉血流速度及神经功能评分的相关性[J]. 中国脑血管病杂志, 2018, 15(8): 414-919.
28
Yoon S, Burkhardt JK, Lawton MT. Long-term patency in cerebral revascularization surgery: an analysis of a consecutive series of 430 bypasses [J]. J Neurosurg, 2018, 131(1): 80-87.
[1] 刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[2] 林乐清, 曹伟, 唐泽文, 王白永, 王磊, 张宁, 唐文学. 脓毒性休克患者液体复苏时外周灌注指数的临床指导价值研究[J]. 中华危重症医学杂志(电子版), 2022, 15(06): 460-465.
[3] 李凤仪, 李若凡, 高旭, 张超凡. 目标导向液体干预对老年胃肠道肿瘤患者术后血流动力学、胃肠功能恢复的影响[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 29-32.
[4] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[5] 张宏江, 刘雪莲, 郑立. 阿芬太尼联合丙泊酚麻醉在小儿腹腔镜疝囊高位结扎术的效果观察[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(06): 711-715.
[6] 李祥魁, 薛玉荣, 丁凯, 孔劲松. ESPB、SAPB、TPVB对胸腔镜微创术血流动力学、应激反应的影响[J]. 中华肺部疾病杂志(电子版), 2023, 16(02): 245-247.
[7] 王英, 薛意恒, 刘国勤. 肠系膜下动脉-高位结扎后降乙结肠血流通路重建机制研究方法的探索历程[J]. 中华结直肠疾病电子杂志, 2023, 12(04): 265-271.
[8] 马丽. CT灌注联合血管成像预测急性脑梗死患者近期神经功能预后的价值分析[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(04): 229-234.
[9] 王姗姗, 徐小汝, 史振仙, 张德杰. 丹参多酚酸联合尤瑞克林治疗急性分水岭脑梗死的疗效及对认知功能、脑血流动力学和血清LPA、ox-LDL、MMP-9水平的影响[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(03): 142-149.
[10] 李田利, 张照龙, 孙成建, 刘国平, 谢宜兴, 赵晓龙, 邵黎明, 郑璇, 王长鑫, 徐锐. 基于血流动力学、血脂及外周血炎症标志物的眼段动脉瘤破裂风险相关研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(02): 78-83.
[11] 陈晓琴, 李星江, 胡涛, 赵金义, 薛培源, 刘伟, 王崇, 胡明成. 椎基底动脉迂曲扩张症的计算流体力学分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(01): 21-25.
[12] 梁晓宁, 吕朝阳, 郭瑞君. 床旁超声在同期胰肾联合移植治疗I型糖尿病术后的检查思路与探讨[J]. 中华临床医师杂志(电子版), 2022, 16(06): 553-557.
[13] 王彦旭, 何益港, 秦永林. 计算流体力学研究B型主动脉夹层中4D Flow MRI的应用进展[J]. 中华介入放射学电子杂志, 2023, 11(02): 159-163.
[14] 季鹏, 郭言言, 王超. CT灌注成像联合CT血管造影对TIA患者进展为急性脑梗死的预测[J]. 中华介入放射学电子杂志, 2023, 11(02): 128-132.
[15] 郝莉茹, 林永俭, 马英东, 陈卓萍, 刘丽. 一例DSA引导下左侧颈动脉内膜剥离取栓术的护理配合[J]. 中华介入放射学电子杂志, 2023, 11(01): 78-81.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号