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。

Study of 320-detector row CT perfusion imaging in acute cerebral infarction

Objective To investigate the value of 320-detector row CT perfusion imaging in acute cerebral infarction.Methods CT perfusion imaging was performed in 33 patients with cerebral infarction treated in Zhumadian Central Hospital from Jan.2014 to Jan.2016.The cerebral blood flow (CBF),cerebral blood volume (CBV),peak time (TTP) and mean transit time (MTT) were measured in the infarct core area,ischemic penumbra (IP) and contralateral mirror area.The relative cerebral blood flow (rCBF),the relative cerebral blood volume (rCBV),relative peak time (rTTP),relative mean transit time (rMTT) in the infarct core area and IP were calculated and analyzed.Results Of the 33 patients,cranial scan found that 9 cases had the signs of early cerebral infarction,the remaining 24 cases found no abnormalities.33 patients underwent CTP imaging showed abnormal perfusion areas,of which 25 cases were found IP.Compared with the contralateral mirror area,CBV had no significant difference (P ＞0.05),and TTP,MTT were significantly prolonged,CBF decreased significantly,the difference was statistically significant (P ＜0.05).Compared with the infarction core area,the increase of CBF,CBV,TTP shortening and MTT prolongation were statistically significant (P＜0.05).There were significant differences on rCBF,rCBV,rTTP,rMTT between IP and infarct core area (P ＜ 0.05).IP was found in 10 patients with hyperacute cerebral infarction,11 cases of 15 patients with acute cerebral infarction and 4 cases of 11 patients in subacute phase.6 cases were in stage Ⅰ 2,12 cases in stage Ⅱ 1,7 cases in stage Ⅱ 2.Conclusion 320-detector row CT perfusion imaging can gain CT,CTP,CTA data by injection of contrast medium once,and provide clear imaging evidence for the area of cerebral lesions and the stage of IP in patients with cerebral infarction.It provides the possibility for clinical individualized treatment for patients,with a lower radiation dose and higher safety.