Use of various CT imaging methods for diagnosis of acute ischemic cerebrovascular disease

Thirty-four patients with cerebral infarction and 18 patients with transient ischemic attack were examined by multi-slice spiral CT scan, CT perfusion imaging, and CT angiography within 6 hours after onset. By CT perfusion imaging, 29 cases in the cerebral infarction group and 10 cases in the transient ischemic attack group presented with abnormal blood flow perfusion, which corresponded to the clinical symptoms. By CT angiography, various degrees of vascular stenosis could be detected in 41 patients, including 33 in the cerebral infarction group and eight in the transient ischemic attack group. The incidence of intracranial artery stenosis was higher than that of extracranial artery stenosis. The intracranial artery stenosis was located predominantly in the middle cerebral artery and carotid artery siphon, while the extracranial artery stenosis occurred mainly in the bifurcation of the common carotid artery and the opening of the vertebral artery. There were 34 cases (83%) with convict vascular stenosis and perfusion abnormalities, and five cases (45%) with perfusion abnormalities but without convict vascular stenosis. The incidence of cerebral infarction in patients with National Institutes of Health Stroke Scale scores ≥ 5 points during onset was significantly higher than that in patients with National Institutes of Health Stroke Scale scores < 5 points. These experimental findings indicate that the combined application of various CT imaging methods allows early diagnosis of acute ischemic cerebrovascular disease, which can comprehensively analyze the pathogenesis and severity of acute ischemic cerebrovascular disease at the morphological and functional levels.     

Magnetic resonance perfusion imaging evaluation in perfusion abnormalities of the cerebellum after supratentorial unilateral hyperacute cerebral infarction

Magnetic resonance imaging (MRI) data of 10 patients with hyperacute cerebral infarction (≤6 hours) were retrospectively analyzed.Six patients exhibited perfusion defects on negative enhancement integral maps,four patients exhibited perfusion differences in pseudo-color on mean time to enhance maps,and three patients exhibited perfusion differences in pseudo-color on time to minimum maps.Dynamic susceptibility contrast-enhanced perfusion weighted imaging revealed a significant increase in region negative enhancement integral in the affected hemisphere of patients with cerebral infarction.The results suggest that dynamic susceptibility contrast-enhanced perfusion weighted imaging can clearly detect perfusion abnormalities in the cerebellum after unilateral hyperacute cerebral infarction.     

Xueshuantong improves cerebral blood perfusion in elderly patients with lacunar infarction

A total of 64 patients with acute lacunar infarction were enrolled within 24 hours of onset. The patients received conventional therapy (antiplatelet drugs and hypolipidemic drugs) alone or conventional therapy plus 450 mg Xueshuantong once a day. The main ingredient of the Xueshuantong lyophilized powder used for injection was Panax notoginseng saponins. Assessments were made at admission and at discharge using the National Institutes of Health Stroke Scale, the Activity of Daily Living and the Mini-Mental State Examination. Additionally, the relative cerebral blood flow, relative cerebral blood volume and relative mean transit time in the region of interest were calculated within 24 hours after the onset of lacunar infarction, using dynamic susceptibility contrast magnetic resonance perfusion imaging technology. Patients underwent a follow-up MRI scan after 4 weeks of treatment. There was an improvement in the Activity of Daily Living scores and a greater reduction in the scores on the National Institutes of Health Stroke Scale in the treatment group than in the control group. However, the Mini-Mental State Examination scores showed no significant differences after 4 weeks of treatment. Compared with the control group, the relative cerebral blood flow at discharge had increased and showed a greater improvement in the treatment group. Furthermore, there was a reduction in the relative mean transit time at discharge and the value was lower in the treatment group than in the control group. The experimental findings indicate that Xueshuantong treatment improves neurological deficits in elderly patients with lacunar infarction, and the mechanism may be related to increased cerebral perfusion.     

A new approach to ischemic brain edema and infarct

Objective: To study the feasibility and efficiency of treatment in the patients with acute moderate and severe ischemic stroke with Neurotropin for its principle of inhibiting cerebral edema and repairing injured neurons. Methods: A randomized controlled trial with Neurotropin was performed in 50 patients admitted within 48h after an acute internal carotid artery infarction, Neurological deficits score ( Europe Stroke Scale-ESS ) ＜80 marks and the area of infarct and edema＞2.25cm2. There were 31 patients in the Neurotropin group and 19 patients in the control group. Basic treatment was Troxerutin 250 mg intravenous drip per day for 21 days in two groups. Additionally, the patients in the Neurotropin group were intravenous injected 106 ampoule Neurotropin (3.6 unit per ampoule), divided into 11 days. We evaluated Neurological deficits score (ESS), ability of daily living (ADL)- Barthel Index, the size and average CT density of infarct and edema area on CT scan during different treatment stage and analyzed.them with statistics. Results: The percentage of improved patients (complete and partial recovery) reaches 64.5% in the Neurotropin group and 31.6% in the control group. The size of the infarct and edema area on CT scan is significantly reduced only in the Neurotropin group after treatment. The average range reduced is 28% on day 11 and 41.5% on day 21, and the average CT density in the Neurotropin group is more advanced than in the control group after onset. Conclusion: Neurotropin can be used as an effective therapy in acute ischemic stroke and ischemic cerebral edema.     

神经保护药物干预短暂性脑缺血的临床分析

Transient ischemic attack(TIA) is an acute cerebrovascular incident,and is generally considered the best opportunity for early neuroprotective treatment against cerebral ischemia.This study retrospectively analyzed 80 patients with TIA(38 males and 42 females).Among 61 patients who received neuroprotective cerebrolysin treatment within 24 hours after TIA onset,13(21.31%) patients suffered subsequent strokes.Among 19 patients who received neuroprotective cerebrolysin treatment within 24-72 hours after TIA onset,seven(36.84%) developed cerebral infarction.There was a significant difference in the proportion of subsequent strokes between patients receiving cerebrolysin treatment within 24 hours and 24-72 hours after TIA onset(P = 0.438).These findings suggest that neuroprotective drugs administrated within 24 hours after TIA onset help reduce the incidence of subsequent strokes.The results demonstrate usefulness of the ABCD2 score at TIA patients in the determination of short-term and long-term cerebrovascular risk,including the frequency of subsequent ischemic cerebral infarctions up to 12 months.     

Xenon-enhanced CT assessment of cerebral blood flow in stroke-in-progress patients with unilateral internal carotid artery or middle cerebral artery stenosis

Carotid or cerebral artery stenosis resulting in low perfusion is a major cause of ischemic stroke.Understanding the unique hemodynamic features in each patient undergoing a stroke-in-progress（SIP） and the correlation between progression and cerebral blood flow（CBF） status would help in the diagnosis and treatment of individual patients.We used xenonenhanced CT（Xe-CT） to examine cerebral perfusion in patients with or without SIP（30 patients/group）,recruited from October 2009 to October 2010.Only SIP patients with unilateral stenosis in the internal or middle cerebral artery were recruited.The occurrence of watershed infarction was higher in the SIP group than in the non-SIP group（P ＆lt;0.05）.In the SIP group,larger hypoperfused areas were found around the lesions than in the non-SIP group.In the SIP group,the CBF values in the ipsilateral areas were significantly lower than those in corresponding regions on the contralateral side.CBF values in the contralateral hemisphere were significantly lower in the SIP group than in the non-SIP group.In SIP patients,infarctions were surrounded by larger hypoperfused areas than in non-SIP patients.These larger hypoperfused areas may result in pathological damage to the brain that is responsible for the progression of stroke.     

急性脑梗死患者上气道形态变化

Objective To investigate the feature of the morphology changes in the upper airway in patients with acute cerebral infarction and to find a new method to prevent and cure cerebral infarction.Methods Sixty-six patients with cerebral infarction confirmed by brain MRI or CT scan(within 3 weeks of onset) were recruited.The patients were examined by upper airway MRI scan and polysomnography (PSG).Then the patients were divided into obstructive sleep apnea hypopnca syndrome(OSAHS)group and non-OSAHS group.In addition.16 patients showing OSAHS but without stroke history(OSAHS nonstroke group)were included in the study.The sagittal and horizontal lengths of the nasopharynx,palatopharynx,glossopharynx and hypopharynx were measured and their closs-sectional areas were calculated.The length,thickness and cross-sectional area of the palate were also measured.Statistic analysis of each data among the groups was performed using SPSS software.Results Among 66 cases with acute cerebral infarction,75.8 % (50/66)were diagnosed with OSAHS.The anteropesterior diameer,left and right diameters and smallest section area in upper airway were all smaller in the OSAHS group with acute cerebral infaretion than those in the non-OSAHS group and OSAHS non-stroke group.The narrowest segments in upper airway were nasopharynx and ompharynx.which are caused by shortened left and right diameters.The area of the soft palate in the OSAHS-stroke group was significant bigger((452.2±99.6)mm2)than that in non-OSAHS group((350.0±69.4)mm2,t:4.575,P<0.05).The lowest SO2 in OSAHS-stroke group(68.9 % ±10.5 % )was the lowest among three groups.The more severe the airway constriction was.the higher the apnea-hypopnea index(AHI)was and the lower the lowest SO2 was.Conclusion Patients withl stroke show higher incidence of OSAHS and present more severe multilevel upper airway constriction.Upper airway constriction may be the new target of early treatment for better prognosis of cerebral infarction.     

急性脑梗死患者上气道形态变化

Objective To investigate the feature of the morphology changes in the upper airway in patients with acute cerebral infarction and to find a new method to prevent and cure cerebral infarction.Methods Sixty-six patients with cerebral infarction confirmed by brain MRI or CT scan(within 3 weeks of onset) were recruited.The patients were examined by upper airway MRI scan and polysomnography (PSG).Then the patients were divided into obstructive sleep apnea hypopnca syndrome(OSAHS)group and non-OSAHS group.In addition.16 patients showing OSAHS but without stroke history(OSAHS nonstroke group)were included in the study.The sagittal and horizontal lengths of the nasopharynx,palatopharynx,glossopharynx and hypopharynx were measured and their closs-sectional areas were calculated.The length,thickness and cross-sectional area of the palate were also measured.Statistic analysis of each data among the groups was performed using SPSS software.Results Among 66 cases with acute cerebral infarction,75.8 % (50/66)were diagnosed with OSAHS.The anteropesterior diameer,left and right diameters and smallest section area in upper airway were all smaller in the OSAHS group with acute cerebral infaretion than those in the non-OSAHS group and OSAHS non-stroke group.The narrowest segments in upper airway were nasopharynx and ompharynx.which are caused by shortened left and right diameters.The area of the soft palate in the OSAHS-stroke group was significant bigger((452.2±99.6)mm2)than that in non-OSAHS group((350.0±69.4)mm2,t:4.575,P<0.05).The lowest SO2 in OSAHS-stroke group(68.9 % ±10.5 % )was the lowest among three groups.The more severe the airway constriction was.the higher the apnea-hypopnea index(AHI)was and the lower the lowest SO2 was.Conclusion Patients withl stroke show higher incidence of OSAHS and present more severe multilevel upper airway constriction.Upper airway constriction may be the new target of early treatment for better prognosis of cerebral infarction.     

急性脑梗死患者上气道形态变化

Objective To investigate the feature of the morphology changes in the upper airway in patients with acute cerebral infarction and to find a new method to prevent and cure cerebral infarction.Methods Sixty-six patients with cerebral infarction confirmed by brain MRI or CT scan(within 3 weeks of onset) were recruited.The patients were examined by upper airway MRI scan and polysomnography (PSG).Then the patients were divided into obstructive sleep apnea hypopnca syndrome(OSAHS)group and non-OSAHS group.In addition.16 patients showing OSAHS but without stroke history(OSAHS nonstroke group)were included in the study.The sagittal and horizontal lengths of the nasopharynx,palatopharynx,glossopharynx and hypopharynx were measured and their closs-sectional areas were calculated.The length,thickness and cross-sectional area of the palate were also measured.Statistic analysis of each data among the groups was performed using SPSS software.Results Among 66 cases with acute cerebral infarction,75.8 % (50/66)were diagnosed with OSAHS.The anteropesterior diameer,left and right diameters and smallest section area in upper airway were all smaller in the OSAHS group with acute cerebral infaretion than those in the non-OSAHS group and OSAHS non-stroke group.The narrowest segments in upper airway were nasopharynx and ompharynx.which are caused by shortened left and right diameters.The area of the soft palate in the OSAHS-stroke group was significant bigger((452.2±99.6)mm2)than that in non-OSAHS group((350.0±69.4)mm2,t:4.575,P<0.05).The lowest SO2 in OSAHS-stroke group(68.9 % ±10.5 % )was the lowest among three groups.The more severe the airway constriction was.the higher the apnea-hypopnea index(AHI)was and the lower the lowest SO2 was.Conclusion Patients withl stroke show higher incidence of OSAHS and present more severe multilevel upper airway constriction.Upper airway constriction may be the new target of early treatment for better prognosis of cerebral infarction.     

急性脑梗死患者上气道形态变化

Objective To investigate the feature of the morphology changes in the upper airway in patients with acute cerebral infarction and to find a new method to prevent and cure cerebral infarction.Methods Sixty-six patients with cerebral infarction confirmed by brain MRI or CT scan(within 3 weeks of onset) were recruited.The patients were examined by upper airway MRI scan and polysomnography (PSG).Then the patients were divided into obstructive sleep apnea hypopnca syndrome(OSAHS)group and non-OSAHS group.In addition.16 patients showing OSAHS but without stroke history(OSAHS nonstroke group)were included in the study.The sagittal and horizontal lengths of the nasopharynx,palatopharynx,glossopharynx and hypopharynx were measured and their closs-sectional areas were calculated.The length,thickness and cross-sectional area of the palate were also measured.Statistic analysis of each data among the groups was performed using SPSS software.Results Among 66 cases with acute cerebral infarction,75.8 % (50/66)were diagnosed with OSAHS.The anteropesterior diameer,left and right diameters and smallest section area in upper airway were all smaller in the OSAHS group with acute cerebral infaretion than those in the non-OSAHS group and OSAHS non-stroke group.The narrowest segments in upper airway were nasopharynx and ompharynx.which are caused by shortened left and right diameters.The area of the soft palate in the OSAHS-stroke group was significant bigger((452.2±99.6)mm2)than that in non-OSAHS group((350.0±69.4)mm2,t:4.575,P<0.05).The lowest SO2 in OSAHS-stroke group(68.9 % ±10.5 % )was the lowest among three groups.The more severe the airway constriction was.the higher the apnea-hypopnea index(AHI)was and the lower the lowest SO2 was.Conclusion Patients withl stroke show higher incidence of OSAHS and present more severe multilevel upper airway constriction.Upper airway constriction may be the new target of early treatment for better prognosis of cerebral infarction.     

短暂性脑缺血发作的动态CT灌注成像与缺血再发作的关系

目的探讨短暂性脑缺血发作(transient ischemic attack,TIA)患者CT灌注成像(CT perfusion,CTP)的变化,为预防TIA再发提供判断依据。方法经临床确诊的TIA患者20例于急性期先行常规16排螺旋CT横断面平扫,然后根据累及的动脉系统,选择感兴趣平面行脑CT灌注扫描,同时行CT血管造影。1个月后复查脑CT灌注。结果20例患者中,在急性期大部分患者患侧局部脑血流(regional cerebral blood flow,rCBF)呈轻到中度异常,患侧局部脑血容量(regional cerebral blood volume,rCBV)呈正常或轻度下降。1个月后复查CT脑灌注结果显示有12例患者未发现异常,8例患者rCBF呈轻到中度下降,患侧rCBV呈正常或轻度下降,随访1年,14例未复发。6例两次CT灌注均有异常者在1年内有5例TIA再发,1例发展为脑梗死。结论对于脑灌注量降低严重而且持续时间长的TIA患者,提示可能出现TIA再发或进展为脑梗死,应及时强化抗缺血治疗。     

CT灌注成像联合CT血管造影诊断超早期缺血性脑血管病的价值

目的 研究CT灌注成像(CTPI)联合CT血管造影(CTA)对超早期缺血性脑血管病(ICVD)的诊断价值。方法 对46例ICVD患者，在发病6h内进行头颅CT平扫、CTPI及CTA检查。结果 (1)CT平扫：显示低密度灶5例，未见异常41例；(2)CTPI：脑血流灌注正常16例，异常30例；(3)CTA：27例患者大脑中动脉(MCA)、大脑前动脉(ACA)不同程度狭窄，2例MCA明显变细，17例CTA图像正常；(4)25例大、中体积脑梗死患者CTPI图像均显示相应灌注缺损区，CTA均显示血管狭窄或闭塞。9例小体积脑梗死患者中，CTPI显示灌注缺损区5例，正常4例；CTA显示血管狭窄2例，正常7例。12例短暂性脑缺血发作(TIA)患者CTPI均正常，2例CTA显示MCA明显变细，远侧血管网增多；其余10例正常。结论 CTPl联合CTA能够超早期诊断ICVD，并可鉴别TIA及不同梗死体积的脑梗死。     

急性脑梗死的320排动态容积CT脑灌注成像研究

目的研究320排动态容积CT全脑灌注成像(CTP)在脑梗死患者中的价值。方法对2014-01—2016-01驻马店市中心医院收治的33例脑梗死患者采取CT全脑灌注成像检查,测量梗死核心区、缺血半暗带(IP)与健侧镜像区的脑血流量(CBF)、脑血容量(CBV)、达峰时间(TTP)及平均通过时间(MTT)值,计算梗死核心区及IP的相对脑血流量(rCBF)、相对脑血容量(rCBV)、相对达峰时间(rTTP)、相对平均通过时间(rMTT),并进行对比分析。结果 33例患者中,头颅平扫发现9例早期脑梗死征象,其余24例未发现异常。33例患者行CTP成像均发现异常灌注区,其中25例存在IP;与健侧镜像区对比,CBV无显著差异(P0.05),而TTP、MTT值明显延长,CBF显著降低,差异有统计学意义(P0.05);与梗死核心区对比,CBF、CBV升高,TTP缩短,MTT延长,差异均有统计学意义(P0.05)。IP区与梗死核心区rCBF、rCBV、rTTP、rMTT对比,差异有统计学意义(P0.05)。10例超急性期(发病6h以内)、15例急性期(发病6~72h)中11例、8例亚急性期(发病72h~14d)中4例存在IP。缺血半暗带分期:Ⅰ2期6例,Ⅱ1期12例,Ⅱ2期7例。结论 320排动态容积CT全脑灌注成像可通过注射一次对比剂获得常规CT、CTP、CTA数据,对脑梗死患者的病变部位、范围及有无IP等提供明确的影像学依据,且可对IP进行分期,为临床实现对患者的个体化治疗提供了可能,且显著降低了患者所受的辐射剂量,安全性高。     

MRI三维动脉自旋标记法对TIA的诊断价值

目的本研究拟运用MRI三维动脉自选标记法(3D-ASL),结合DWI及时间飞跃法MRA(3DTOF-MRA),探讨3D-ASL在TIA的诊断、血流灌注评估等方面的应用价值,为临床超早期诊断、治疗提供更多的理论依据。方法发病24 h内的TIA患者13例,入院时进行常规MRI、DWI、3D-TOF-MRA及3D-ASL扫描。观察所有患者MRA图,分析颅内血管及颈内动脉有无狭窄及异常,比较DWI所示梗死面积(SDWI)和全脑血流量(CBF)图上灌注异常面积(SASL)的差异,分别计算DWI和3D-ASL对TIA患者的检出率,并结合MRA分析造成脑组织血流灌注异常的原因。对于DWI阴性但ASL灌注异常,且MRA(或CTA)显示血管狭窄的患者,计算病灶侧和对侧相应区域的CBF值的比值(rCBF),比较rCBF与入院时(发病24 h内)的NIHSS、Glasgow昏迷评分量表(GCS)、mRS及神经内科临床评分量表(ABCD2)评分、患者发病时间以及一过性脑缺血症状发作持续时间有无相关性,并且比较分析rCBF值与MRA(或CTA)所示血管直径狭窄程度的相关性。结果(1)SASL>SDWI:13例TIA患者中,11例DWI未发现病灶,即SDWI=0,而SASL>0,且显示灌注减低;2例DWI阳性,但病灶面积仍SASL>SDWI。(2)3D-ASL对TIA的检出率明显高于DWI:DWI对TIA患者病灶的检出率为15%;3D-ASL对TIA患者病灶的检出率为69%。(3)rCBF与入院时(发病24 h内)的NIHSS、GCS、mRS及ABCD2评分的分值均无相关性;rCBF与患者发病时间及一过性脑缺血症状发作持续时间无相关性;rCBF值与MRA(或CTA)所示血管直径狭窄程度呈负相关关系(rs=-0.697,P=0.011)。结论3DASL与DWI相比,对TIA的诊断敏感性较高。及早行3D-ASL检查,并与DWI、MRA等序列联合应用,能更早发现灌注异常,并初步提示责任血管狭窄程度,为临床治疗提供科学依据。     

CT灌注成像在超早期缺血性脑血管病的应用研究

目的　探讨CT灌注成像 (CTPI)在超早期缺血性脑血管病中的应用价值。方法　对4 6例缺血性脑血管病患者在发病后 6h内先行普通头颅CT平扫 ,再进行CTPI检查。结果　普通CT平扫显示 :4 6例缺血性脑血管病患者在发病后 6h内 ,显示低密度灶者 5例 ,诊断为脑梗死。未见异常者 4 1例 ,经临床追踪和复查CT证实 ,12例为短暂性脑缺血发作 (TIA) ,2 9例为脑梗死。 4 6例缺血性脑血管病发作 6h内的患者在CTPI显示 :①灌注正常者 16例 ,其中 12例临床诊断为TIA ,4例小体积脑梗死。②灌注异常者 30例 ,其中 2 5例普通CT未显示病灶 ,5例在CTPI显示的病灶范围较普通CT显示的病灶范围增大。CTPI异常的 30例患者rCBF、TP、MTT改变明显 ,病灶侧与健侧、病灶中心区与周边区比较 ,差异有显著意义 (P <0 .0 5 )。结论　CTPI能够超早期诊断脑梗死 ,并可鉴别诊断TIA。通过分析病灶内的血流灌注状态 ,明确病灶的部位、大小及范围 ,显示了半暗带的存在 ,对于超早期缺血性脑血管病患者选择治疗方案和判断预后具有重要意义。     

CT血管成像及血流灌注对脑动脉狭窄及缺血性脑血管病的诊断价值

目的:应用多层螺旋CT(MSCT)采用CT血管成像(CTA)与CT灌注成像(CTPI)相结合的技术探讨对脑动脉狭窄及缺血性脑血管病的诊断价值及超早期治疗的价值。方法:30例急性缺血性脑血管病(AICVD)患者行CT平扫,CTA和CTPI检查。对比观察梗死区和对侧对照区,梗死病灶中心区与周边区的血流动力学参数数值;分析AICVD与CTA变化的关系。结果:30例AICVD患者,CT平扫10例短暂性脑缺血发作(TIA)患者均未见异常,20例脑梗死(CI)患者有1例有小灶性低密度。CTA显示10例TIA患者中正常8例,狭窄2例;20例CI患者中19例均有不同程度的动脉狭窄,1例正常,为脑干梗死。CTPI显示未见异常者12例,其中10例TIA,2例CI(1例基底节区腔隙梗死,1例脑干梗死)。灌注异常者18例中,梗死侧与健侧、病灶中心与周边区rCBF、rCBV、TTP的差异有统计学意义。结论:CTA联合CTPI对早期AICVD有诊断价值,并能指导临床进行合理治疗。     

116例大脑中动脉病变患者脑梗死类型分布和脑灌注异常分析

目的 应用神经影像检查,分析大脑中动脉闭塞性疾病(MCAOD)患者梗死类型分布和脑灌注异常. 方法 对经CT血管造影(CTA)证实的116例MCAOD患者的CT平扫、CT灌注成像(CTP)和CTA的影像资料进行回顾性分析,确定其脑梗死类型分布和脑灌注改变. 结果 116例患者中,CTA共检出133条大脑中动脉(MCA)狭窄或闭塞,其中单侧者99例,双侧者17例.其中MCA闭塞25条,重度狭窄39条,中、轻度狭窄69条.CT或MRI显示腔隙性脑梗死(LIS)45例,各型分水岭脑梗死(CWSI)38例,流域性脑梗死26例,纹状体内囊梗死(SCI)10例,未检出梗死病灶14例.CTP显示MCA供血区内脑血流灌注异常96例,其中58例有MCA供血区的大范围血流灌注减低.未检出血流灌注异常者37例. 结论 由于MCA狭窄的部位、程度和发病机制的不同以及侧支循环的建立,MCAOD可造成不同类型的脑梗死和血流灌注异常.     

缺血性脑卒中早期CT灌注成像的临床应用价值

目的 探讨缺血性脑卒中早期CT灌注成像（CTPI）的临床应用价值。方法 对45例发病24h内的缺血性脑卒中患者行头颅CT平扫与CTPI检查，计算缺血半暗带区及梗死区相对脑血流量（rCBF）、相对脑血容量（rCBV）、相对平均通过时间（rMTT）、相对峰值时间（rTTP）、相对峰值增强（rPE）的灌注参数及各个参数图异常灌注区面积。结果 CT平扫显示脑缺血性改变29例，其中为责任病灶21例，未见异常16例，未见责任病灶24例；对缺血性脑卒中早期诊断的敏感性为46．67％（21／45），特异性为72．41％（21／29）。CTPI显示灌注异常44例，均为责任病灶；灌注正常1例，后经头颅MRI证实为急性脑干梗死；对缺血性脑卒中早期诊断的敏感性为97．78％（44／45），特异性为100％（44／44）。CTPI较CT平扫对急性脑缺血性病灶更敏感（P〈0．01）。缺血半暗带区及梗死区各个灌注参数相对值之间呈正相关（均P〈0．01）。CTPI各个参数图异常灌注区面积之间呈正相关（均P〈0．01）。结论 CTPI能够早期诊断缺血性脑卒中；定量分析可区分中心梗死区、缺血半暗带区，有助于早期选择治疗方案。     

头颅移动CT灌注扫描对重型颅脑损伤患者的临床价值

目的 探讨移动CT灌注扫描（CTP）在重型颅脑损伤（TBI）患者中的临床应用价值。方法 2015年4~9月我院神经外科重症监护室收住重型TBI患者26例,受伤24 h之内同时进行头颅CT平扫（CT1）和移动CTP,并在5 d后复查头颅CT平扫（CT5）。CTP提供脑血流量（CBF）影像、脑血容量（CBV）影像及平均转运时间（MTT）影像;将CTP影像、CT1及CT5进行比较。结果 CTP平均在伤后（15.6±4）h进行。16例（61.5%）患者CTP影像显示灌注改变区域大于CT1显示的病灶区域,其中7例（27%）患者低灌注程度达到缺血水平。3例（11.5%）患者通过CTP扫描发现严重的脑灌注不足,尽管在CT5上并没有明显的缺血梗死表现,根据CTP结果,改变此3例患者的治疗方案,最终只有1例发生严重脑梗死,另外2例恢复良好。与CT1相比,CTP与CT5结果具有更好的一致性。结论 头颅移动CTP可以在创伤后早期对重型TBI患者的脑血流灌注情况作出较为准确的评估,为临床干预提供有力依据。