中文摘要：

目的 探讨脑出血亚急性及慢性期血肿周围组织脑血液动力学变化及其相关影响因素。方法 对12例基底节区脑出血患者做了CT常规及灌注成像检查，对其中11例患者血肿体积及血肿周围局部脑血流量（regional cerebral blood flow，rCBF）、局部脑血容量（regional cerebral blood volume，rCBV）、对比剂平均通过时间（mean transit time，MTT）和最大峰值时间（time-to-peak，TTP）的比值（病侧／健侧）进行测量。结果 11例脑出血患者血肿体积最大为72．21ml，最小为13．68ml，血肿平均体积为26．83ml。rCBF参数图显示血肿周围低灌注梯度11例，表现为血肿周围rCBF减低区；rCBV参数图显示血肿周围低灌注梯度10例，表现为血肿周围rCBV减低区；血肿周围高灌注1例，表现为血肿周围rCBV增高区；同侧半球低灌注2例，表现为血肿侧脑组织rCBF、rCBV大面积减低区；时间参数图显示血肿周围TTP延长11例，MTT延长10例；血肿边缘区rCBF显著低于外层区rCBF；边缘区MTT、TTP明显长于外层区MTT、TTP；血肿外层区rCBF、rCBV与血肿边缘区rCBF、rCBV呈线性依从性改变。血肿周围（边缘区和外层区）rCBV与血肿体积有明显的相关性，r边缘区=0．764，r外层区=0．703（双侧），P值均〈0．05。血肿周围rCBF、rCBV、MTT和TTP与症状出现至行CT灌注扫描间期无明显相关性。结论 脑出血亚急性和慢性期，血肿周围脑组织依然存在低灌注梯度，低灌注区脑血流变化与血肿体积密切相关。CT灌注成像可清晰地显示出血肿周围异常的脑血液动力学变化，可为脑出血个体化救治及预后评估提供有价值的信息。

英文摘要：

Objective To study the alteration of cerebral blood flow adjacent to the hematoma in subacute and chronic intracerebral hemorrhage （ICH）, and to investigate its correlative factors. Methods Pre-contrast and dynamic perfusion CT were performed in 12 cases of ICH with the basal ganglia. The volume of hematomas were measured, and the ratios of side-to-side of the regional cerebral blood flow （rCBF） , regional cerebral blood volume （rCBV） , mean transit time （MTI＇） and time-w-peak （TIP） were calculated in 11 of 12 cases. Results The maximum and minimum of hematoma were 72. 21 ml and 13. 68 ml respectively, and the mean was 26. 83 ml. The gradient of perihematomal hypoperfusion was revealed by rCBF maps in 11 cases, and by rCBV maps in 10 cases. The perihematomal hyperperfusion was demonstrated by rCBV maps in 1 case. The hypoperfusion of the affected hemisphere was observed in 2 cases. The areas of delayed TIP and MTT were revealed in 11 cases and 10 cases, respectively. In the regions surrounding the hemorrhage, the reduction in rCBF and the delay in MTT were most pronounced within 2 mm of the hematoma perimeter, and the reduction in rCBV correlated with the volume of hemorrhage clearly. There was no correlation between the changes in rCBF, rCBV, MTT and TTP and the time from symptom onset to CT perfusion imaging. Conclusion In the phases of subacute and chronic intracerebral hemorrhage, the hypoperfusion surrounding the hematoma remains existing. The changes of rCBV in the perilesional regions correlate with the volume of hemorrhage. Perfusion CT and its parameters analysis may play an increasing role in delinating the hypoperfusion around hematomas, and may provide valuable information on the individual clinic therapy and prognostic evaluation of ICH.