MSCT动态扫描在rt-PA溶栓急性脑梗死患者中的应用

目的 探讨多层螺旋CT动态4D扫描用于急性脑梗死患者rt-PA静脉溶栓前后脑部血流灌注及病灶血管成像的临床价值。 方法 回顾性分析2013年2月—2015年2月收治的急性脑梗死行rt-PA静脉溶栓治疗患者共62例多层螺旋CT动态4D扫描资料，比较治疗前后病灶边缘区局部脑血流量(rCBF)、局部脑血容量(rCBV)、达峰时间(TPP)及平均通过时间(MTT)。 结果 全部62例患者rt-PA静脉溶栓前，55例局部动脉血管分支减少，7例脑血管成像未见明显异常；rt-PA静脉溶栓后60例梗死区局部血管分支增多，2例脑血管成像未见明显异常。急性脑梗死患者rt-PA静脉溶栓前rCBF、rCBV、TPP及MTT水平分别为(20.73±5.44)、(1.21±0.30)、(19.37±3.70)、(6.52±0.77)；静脉溶栓后rCBF、rCBV、TPP及MTT水平分别为(37.66±8.10)、(1.96±0.41)、(18.98±4.25)、(6.55±0.81)；静脉溶栓后rCBF和rCBV水平显著优于静脉溶栓前，差异有统计学意义(P＜0.05)；急性脑梗死患者rt-PA静脉溶栓前后TTP和MTT水平比较差异无统计学意义(P＞0.05)。 结论 多层螺旋CT动态4D扫描可准确反映急性脑梗死患者rt-PA静脉溶栓前后脑部血流灌注及病灶血管情况，可为溶栓疗效评价提供可靠依据。 

Application of dynamic 4D CT in patients with acute cerebral infarction undergoing thrombolysis with rt-PA

Objective To investigate the clinical value of dynamic 4D spiral CT for cerebral blood flow perfusion and vascular imaging in patients with acute cerebral infarction before and after thrombolysis with rt-PA. Methods The imaging data of dynamic 4D CT of 62 patients with acute cerebral infarction undergoing thrombolysis with rt-PA were retrospectively analyzed,and the regional cerebral blood flow(rCBF),regional cerebral blood volume(rCBV),peak time(TPP)and mean transit time(MTT)in the focal region of patients with acute cerebral infarction before and after the thrombolysis with rt-PA was compared. Results All 62 patients included 55 cases of local arterial branches decreased for and 7 cases without obvious abnormalities by cerebral angiography;after the thrombolysis with rt-PA,there were 60 cases of the local vascular branches increase,and 2 cases without obvious abnormalities by cerebral angiography.The levels of rCBF,rCBV,TPP and MTT before the thrombolysis were 20.73±5.44,1.21±0.30,19.37±3.70 and 6.52±0.77,respectively,and after thrombolysis were 37.66±8.10,1.96±0.41,18.98±4.25 and 6.55±0.81,respectively.Between the two groups,there were statistical significant difference in the levels of rCBF and rCBV(P<0.05),but not in the levels of TTP and MTT(P>0.05). Conclusion The perfect cerebral blood flow perfusion and vascular imaging in patients with acute cerebral infarction before and after thrombolysis with rt-PA can be shown by dynamic 4D CT and the scan will provide accurate bases for the evaluation of treatment.