Hrushchak N. Diagnostic and prognostic reasoning of the use of multidetector computed tomographic angiography in the assessment of cerebral vessels changes in patients with hypertension

The dissertation is devoted to the efficiency of the diagnosis of the cerebral blood vessels changes in patients with arterial hypertension depending on the level of total cardiovascular risk, using multidetector computed tomographic (MDCT) angiography. To determine the MDCT-semiotics changes of cerebral vessels 151 patients underwent MDCT- angiography of the intracranial vessels. 115 people out of them aged between 20 - 73 years (mean age was 46,5 ± 1,1 years) had the verified diagnosis of hypertension. Taking into consideration high blood pressure, presence of risk factors and target organ damage these people were divided into 3 groups: with low, medium, high and very high level of total cardiovascular risk. 36 patients created a control group. At the time of examination the diagnosis of hypertension among these patients wasn’t found out. For the first time in Ukraine patients with hypertension with various levels of total cardiovascular risk underwent MDCT-angiography to study the changes of the cerebral vessels. The features of normal cerebral vessels anatomy were studied in patients without hypertension, based on MDCT-data. For the first time due to the MDCT-angiography of the cerebral vessels were established anatomical features of the intracranial vessels that may increase blood pressure in patients with hypertension with low, moderate, high and very high levels of total cardiovascular risk. The algorithm of the analysis of MDCT-angiography data proposed to study stenotic and structural changes of the cerebral vessels based on their affiliation to a carotid or vertebro-basilar pool of blood supply to the brain. High diagnostic value of the method of MDCT-angiography in the detection of stenotic and structural changes in cerebral vessels in patients with hypertension with various levels of total cardiovascular risk was proved. MDCT-diagnostic criteria for assessing of stenotic (hemodynamically significant and hemodynamically not significant) and structural changes of cerebral vessels were established and proved that this changes were the most prevalent in patients with hypertension with high and very high level of total cardiovascular risk. Correlation analysis of the MDCT-data was done and found out that an increase in the level of total cardiovascular risk in patients with hypertension increases the incidence of stenotic lesions of the internal carotid, posterior communicating, vertebral arteries, and deducted for these vessels Pearson correlation coefficients corresponding to the level of high statistical significance p .0,01 and for anterior cerebral artery - the level of statistical significance p. 0.05.