CT灌注源图像在诊断超急性期缺血性脑卒中的应用价值

目的 探讨CT灌注源图像(CTPSI)在超急性期缺血性脑卒中诊断中的临床应用价值.方法 100例急性缺血性脑卒中(发病时间＜9 h)的患者行"一站式"CT检查,根据动脉期与静脉期CTPSI Alberta卒中早期CT评分(ASPECTS)的不同将100例患者分为2组:有延迟灌注组和无延迟灌注组.分析基线平扫CT、动脉期及静脉期CTPSI ASPECTS,并与随访影像AS-PECTS进行对照.Wilcoxon秩和检验比较动脉期CTP SI与静脉期CTPSI ASPECTS之间的统计学差异;应用多元线性回归分析基线"一站式"CT各个影像学形态ASPECTS与随访影像ASPECTS之间的线性依存关系.结果 100例患者分为有延迟灌注组42例和无延迟灌注组58例.基线平扫CT、动脉期、静脉期和随访影像的ASPECTS中位数(最小值～最大值)在有延迟灌注组分别为:8.0(6.0～10.0)、7.0(1.0～8.0)、8.0(3.0～10.0)、7.5(0～10.0);在无延迟灌注组分别为:8.0(1.0～10.0)、7.5(1.0～10.0)、8.5(1.0～10.0)、7.0(0～10.0).在无延迟灌注组,动脉期与静脉期CTPSI ASPECTS差异无统计学意义(Z=-1.00,P=0.459),而在有延迟灌注组,两者差异有统计学意义(Z=-3.08,P=0.001).在无延迟灌注组,基线影像ASPECTS(平扫CT、动脉期及静脉期CTPSI)与随访影像AS-PECTS均存在正相关(r值分别为0.879、0.902、0.945,P值均＜0.01);在有延迟灌注组,静脉期CTPSI与随访影像ASPECTS的相关性最好(r=0.831,P=0.004).多元线性回归结果显示只有静脉期CTPSI与随访影像ASPECTS之间的线性关系有统计学意义:无延迟灌注组,标准化回归系数β=0.946,P＜0.001;有延迟灌注组,β=0.714,P=0.003.结论 CTPSI显示无延迟灌注者不存在缺血半暗带,提示不适合溶栓治疗;有延迟灌注者提示存在缺血半暗带,是溶栓治疗的重要依据之一.     

CT灌注原始图像不匹配模型评价急性缺血性脑卒中缺血半暗带和梗死核心的价值

目的 评价CT灌注原始图像(CT perfusion source images,CTP-SI)不匹配模型在判断缺血半暗带和梗死核心中的价值.方法 24例急性缺血性脑卒中患者(发病时间＜9 h)行"一站式急性缺血性脑卒中CT"扫描,分析基线动脉期及静脉期CTP-SI Alberta卒中早期CT评分(Alberta Stroke Program Early CT Score,ASPECTS),并与随访影像ASPECTS进行对照.采用Wilcoxon秩和检验比较动脉期与静脉期CTP-SI ASPECTS之间的统计学差异;应用多元线性回归分析基线动脉期、静脉期CTP-SI与随访影像ASPECTS之间的线件依存关系.结果 基线动脉期、静脉期和随访影像的CTP-SI ASPECTS中位数分别为9.0分(2.0～10.0分)、9.3分(6.5～10.0分)、9.0分(7.0～10.0分).动脉期与静脉期CTP-SI ASPECTS差异有统计学意义(Z=-2.812,P=0.005),10例静脉期CTP-SI ASPECTS大于动脉期,14例静脉期CTP-SI ASPECTS等于动脉期;静脉期CTP-SIASPECTS与随访影像ASPECTS之间的线性依存关系有统计学意义,标准化回归系数(Beta)=0.715,P=0.003.结论 CT灌注原始图像不匹配模型可以预测缺血半暗带和梗死核心,为临床医师制定治疗方案时提供了更多的选择.     

基于CT平扫的ASPECTS与急性缺血性脑卒中核心梗死体积的相关性研究

目的 探讨基于CT平扫(NCCT)的Alberta卒中项目早期CT评分(ASPECTS)与CT灌注成像(CTP)核心梗死体积的相关性,并评估ASPECTS对核心梗死体积<70 ml的预测价值。方法 回顾性分析307例急性缺血性脑卒中(AIS)患者的临床资料。所有患者均因前循环大血管闭塞行NCCT和CTP评估。记录自动化灌注分析软件获得的核心梗死体积,并基于NCCT图像判读ASPECTS。采用Spearman检验分析ASPECTS与核心梗死体积的相关性。采用受试者工作特性(ROC)曲线分析评估ASPECTS预测核心梗死体积<70 ml的效能。结果 307例患者包括116超窗患者(发病时间6～24 h, 104例;醒后卒中,12例)。在所有患者和超窗患者中,ASPECTS均与核心梗死体积呈显著负相关(ρ=-0.797,ρ=-0.825)。ROC曲线分析提示,以ASPECTS≥7分作为阈值,其预测核心梗死体积<70 ml的曲线下面积(AUC)为0.947,敏感度和特异度分别为86.8%和87.5%。在超窗患者中,以ASPECTS≥6分作为阈值,其预测核心梗死体积<70...     

CT灌注联合能谱成像评价射频消融治疗肺癌近期疗效

目的 探讨动态容积CT灌注联合能谱成像在射频消融(RFA)治疗肺癌近期疗效观察中的应用价值.方法 收集已经病理结果证实并拟行治疗的肺腺癌患者30例,术前1～2 d和术后30～40 d均行病灶部位灌注扫描,根据原始图像重建出能谱图像,并对比术前、术后灌注参数血流量(BF)、血容量(BV)、平均通过时间(MTT)、表面通透性(PS)及能谱参数碘(水)基值、水(碘)基值的变化,分析灌注参数及能谱参数对评价RFA治疗肺癌近期疗效的意义.结果 RFA后,全组患者的CT灌注参数及能谱参数值均值均下降,BF(t=7.34,P＜0.001)、BV (t=4.721,P＜0.001)、PS (t=2.224,P=0.034)、动脉期碘(水)基值(t=8.622,P＜0.001)、静脉期碘(水)基值(t=6.608,P＜0.001)及动脉期水(碘)基值(t=4.627,P＜0.001)术前、术后近期差异有统计学意义.RFA前后,缓解组的各参数变化差值均大于复发组,但只有BF(Z=-2.806,P=0.005)、动脉期碘(水)基值(Z=-2.806,P=0.005)及静脉期碘(水)基值(Z=-4.208,P=0.014)变化差值有统计学意义.结论 CT灌注联合能谱成像是一种评价RFA治疗肺癌近期疗效的有效方法.     

增强螺旋CT腹部血管低灌注征象在严重创伤患者低血容量性休克评估中的作用

目的 探讨增强螺旋CT腹部血管低灌注征象对严重创伤患者低血容量性休克评估的意义. 方法 回顾性分析2008年1月-2011年12月收治的63例严重创伤患者的临床及螺旋CT影像学资料,根据螺旋CT检查后24 h内是否发生休克,将患者分为休克组(34例)和稳定组(29例).分析比较两组患者入院时血压、心率、ISS评分、血pH值、血乳酸(Lac)及碱剩余(BE)等指标,并测量增强螺旋CT影像中主动脉、下腔静脉、肠系膜上动、静脉等腹部大血管的直径及增强早期和延迟期CT值. 结果 休克组ISS评分及Lac水平显著高于稳定组,而BE显著低于稳定组(P＜0.05).休克组下腔静脉存在变形塌陷征象,在4个腹部层面最小直径均小于稳定组(P＜0.01).CT增强早期,休克组肠系膜上动脉CT值为(133.2±32.4) HU,低于稳定组的(186.3±23.3) HU(P ＜0.05);下腔静脉肝脏上缘层面CT值为(133.4±20.3) HU,显著高于稳定组的(112.0±21.9) HU(P ＜0.01).而增强延迟期各血管CT值差异无统计学意义. 结论 部分增强螺旋CT腹部血管低灌注征象对严重创伤患者低血容量性休克早期评估有一定参考价值.     

CT动态增强鉴别肾上腺乏脂肪腺瘤与肾上腺结节样增生的价值

目的探讨CT动态增强对鉴别肾上腺乏脂肪腺瘤与肾上腺结节样增生的价值。方法回顾性分析经手术病理证实的12例肾上腺乏脂肪腺瘤和27例肾上腺结节样增生患者的病例资料,统计两组病例各期增强CT值,利用公式灌注值P=CT静脉期-CT平扫期、廓清值C=CT静脉期-CT延迟期、绝对廓清灌注指数APC=(C/P)×100%及相对廓清灌注指数RAPC=(C/CT静脉期)×100%得到相关参数,并通过绘制受试者工作特征曲线,鉴别两者的最佳价值。结果肾上腺乏脂肪腺瘤直径较结节样增生更大;肾上腺乏脂肪腺瘤病灶各期CT值均明显高于结节样增生,且两者灌注值P、廓清值C、APC及RAPC有明显的统计学差异。年龄、性别、高血压、病灶位置、对侧肾上腺萎缩及动脉期CT值对鉴别两者无显著意义。结论CT动态增强扫描有助于鉴别肾上腺乏脂肪腺瘤和肾上腺结节样增生。     

能谱CT虚拟平扫在肾癌中的应用

目的：探讨能谱CT虚拟平扫(VNC)替代常规平扫在肾癌中的临床应用价值。方法回顾分析32例经病理证实为肾癌的患者影像资料,均行能谱CT常规平扫及动脉期、静脉期能谱成像(GSI),采用MSI软件生成动脉期VNC和静脉期VNC图像。分别测量3组图像(常规平扫、动脉期VNC、静脉期VNC)肾脏病灶的CT值、病灶-正常肾脏的对比噪声比(CNR),同层面病灶的长径、橫径,采用单因素方差分析;由2位放射科医师对3组图像分别行5分制图像质量主观评分,3分制影像学征象主观评分,对2位医师评价结果的一致性行Kappa 检验,对3组图像的图像质量主观评分行单因素方差分析。结果2位医师对3组图像评价结果的一致性较好(Kappa 值均>0.700);3组图像间图像质量主观评分无统计学差异(P>0.05);影像学征象主观评分动脉期 VNC为2.88±0.34,静脉期VNC为2.84±0.37,均可接受。3组图像的CNR分别为0.52±0.11、0.72±0.16、0.69±0.12,动脉期VNC、静脉期 VNC的对比噪声比(CNR)均高于常规平扫,有统计学差异(P<0.05)。3组图像同层面病灶的长径和横径无统计学差异(P>0.05)。3组图像肾脏病灶的CT值分别为(30.04±4.09)HU、(32.69±4.07)HU、(32.56±3.52)HU,有统计学差异(P<0.05),常规平扫病灶的CT值低于动脉期 VNC和静脉期 VNC,但差值均在5 HU内。结论在肾癌检查中 VNC能替代常规平扫,可减少患者的扫描次数,降低辐射剂量。     

双低剂量4D-CT灌注替代常规肝脏四期CT成像可行性研究

【摘要】目的:探讨双低剂量4D-CT灌注替代常规肝脏四期CT成像的可行性。方法:对30例肝脏疾病患者行肝脏CT平扫、低辐射剂量及低对比剂浓度的4D-CT灌注成像及延时期成像,通过使用动态血管成像软件对多期灌注图像进行处理,得到融合后平扫期、融合后动脉期、融合后静脉期。对比双低剂量4D-CT灌注总辐射剂量与常规肝脏四期CT成像辐射剂量,融合后平扫图像与常规平扫图像在信噪比、对比噪声比上的差异,并采用主观评分的方法对融合后平扫、融合后动脉期、融合后静脉期图像进行评分。结果:双低剂量肝脏4D-CT灌注成像患者接受的碘剂浓度较低,总辐射剂量为1129.0（1087.0~1296.0）mGy·cm,常规肝脏四期CT成像辐射剂量为（1265.9±284.3）mGy·cm（P=0.136）,两者差异无统计学意义;融合后平扫信噪比5.9（4.8~7.1）,常规平扫信噪比5.8±1.9（P=0.360）,两者差异无统计学意义,融合后平扫肝脏对比噪声比0.90±0.62,常规平扫肝脏对比噪声比1.06（0.61~1.40）,P=0.153,两者差异无统计学意义。4D灌注融合后平扫、融合后动脉期、融合后静脉期图像质量主观评分均≥3分,图像质量满足诊断需求。结论:双低剂量4D-CT灌注替代常规肝脏四期CT成像是可行的,不仅可以得到灌注信息,还能使用动态血管成像软件处理后所得到的融合后平扫、动脉期、静脉期图像能够满足临床诊断需求。     

肺癌的PET/CT检查:对比剂对于定量和临床评估的影响

目的在怀疑肺癌病人的PET/CT检查中,评价静脉对比剂以及不同的对比剂期相对于校正密度、PET影像质量和临床分期的影响。方法选取60例可疑肺癌病人进行18F-FDGPET/CT检查。将所得PET影像与平扫、动脉期和静脉期CT影像融合。测量并比较每个期相锁骨下静脉、升主动脉、腹主动脉、下腔静脉、门静脉、肝、肾和肺内肿块的最大标准摄取值(SUVmax)、平均标准摄取值(SUVmean)和对比强化值(HU)。肉眼直观评价PET数据对临床分期和影像质量的影响。结果在所有解剖部位,增强后PET/CT的SUVmax值都较平扫时明显增加(全部P<0.001)。动脉期的SUVmax值均明显高于静脉期(全部P<0.001)。在实质脏器内,静脉期的SUVmax值则明显高于动脉期(全部P<0.05)。平扫和增强PET/CT对肉眼评估恶性病变无影响(P=1.0)。结论在肺癌的PET/CT检查中,增强CT适合用于进行密度校正,它既不影响病变的临床评估,也不影响PET的影像质量。     

单源双能 CT 对膀胱血肿内膀胱癌病灶的检出价值

目的：探讨单能双源 CT 对膀胱血肿内膀胱癌病灶的检出价值。方法回顾性分析本院行单源双能 CT 能谱扫描(40~140 keV),并经病理或随诊证实的膀胱血肿的患者14例(单纯血肿11例,血肿内膀胱癌3例)。由2位放射学诊断医师在不知病理结果的情况下分别对平扫及增强三期扫描混合能量图像、最佳单能量图像及碘水图像采用5分制进行肿瘤检出及图像质量的主观评分。采用 Kappa 检验评价2位观察者之间的一致性,使用 Mann-Whitney U 检验比较膀胱单纯血肿与血肿内膀胱癌评分有无差异,并使用受试者工作特征曲线(ROC)计算曲线下面积(AUC)、特异度、敏感度,获得其诊断效能。Mann-Whitney U 检验也用于比较同一观察者相同扫描期相混合能量图像、最佳单能量图像及碘水图像间质量评分有无统计学差异。结果各组图像2位观察者病灶检出评分一致性均较好(k =0.51~0.8)。2种疾病间混合能量平扫、动脉期,最佳单能量平扫、动脉期、延迟期图及碘水图各期评分差异均有统计学意义(P <0.05)。碘水图平扫及增强扫描三期图像 AUC 分别为0.985、1.000、0.955、0.924,均高于混合能量平扫及动脉期图像 AUC(0.909、0.909),其中碘水图动脉期诊断效能最高,当评分>2.5分时,诊断膀胱癌排除单纯血肿的敏感度、特异度均为100%。2组病例间混合能量静脉期、延迟期及最佳单能量静脉期图像评分差异无统计学意义(P >0.05)。而同一观察者相同扫描期相3组图像间图像质量评分差异均无统计学意义(P >0.05)。结论单源双能 CT 碘水图相对于常规 CT 检出率明显提高,能有效检出膀胱血肿内的膀胱癌病灶,其中碘水图动脉期诊断效能最高。而单源双能 CT 图像质量较传统 CT 并无明显差异。     

Alberta Stroke Program Early CT Scoring of CT perfusion in early stroke visualization and assessment

BACKGROUND AND PURPOSE: Qualitative CT perfusion (CTP) assessment by using the Alberta Stroke Program Early CT Score (ASPECTS) allows rapid calculation of infarct extent for middle cerebral artery infarcts. Published thresholds exist for noncontrast CT (NCCT) ASPECTS, which may distinguish outcome/complication risk, but early ischemic signs are difficult to detect. We hypothesized that different ASPECTS thresholds exist for CTP parameters versus NCCT and that these may be superior at predicting clinical and radiologic outcome in the acute setting. MATERIALS AND METHODS: Thirty-six baseline acute stroke NCCT and CTP studies within 3 hours of symptoms were blindly reviewed by 3 neuroradiologists, and ASPECTS were assigned. Treatment response was defined as major neurologic improvement when a > or =8-point National Institutes of Health Stroke Scale improvement at 24 hours occurred. Follow-up NCCT ASPECTS and 90-day modified Rankin score (mRS) were radiologic and clinical reference standards. Receiver operating characteristic curves derived optimal thresholds for outcome. RESULTS: Cerebral blood volume and NCCT ASPECTS had similar radiologic correlations (0.6 and 0.5, respectively) and best predicted infarct size in the absence of major neurologic improvement. A NCCT ASPECT threshold of 7 and a cerebral blood volume threshold of 8 discriminated patients with poor follow-up scans (P < .0002 and P = .0001) and mRS < or =2 (P = .001 and P < .001). Only cerebral blood volume predicted major neurologic improvement (P = .02). Interobserver agreement was substantial (intraclass correlation coefficient, 0.69). Cerebral blood volume ASPECTS sensitivity, specificity, positive predictive value, and negative predictive value for clinical outcome were 60%, 100%, 100%, and 45%, respectively. No patients with cerebral blood volume ASPECTS <8 achieved good clinical outcome. CONCLUSION: Cerebral blood volume ASPECTS is equivalent to NCCT for predicting radiologic outcome but may have an additional benefit in predicting patients with major neurologic improvement.     

单期和多期CT血管造影评估缺血性脑卒中患者侧支状态与CT灌注参数的对比性研究

目的 对于急性缺血性脑卒中(AIS)大脑中动脉闭塞患者,比较单时相、多时相CT血管造影(sCTA、mC-TA)评估的侧支循环评分与定量灌注参数之间的关联性及在预测临床预后中的价值.方法 搜集2019年12月至2020年12月于急救中心行一站式CT检查的发病时间在24 h内的大脑中动脉闭塞患者的临床资料及影像学资料,从C...     

Accuracy of the Alberta Stroke Program Early CT Score during the first 3 hours of middle cerebral artery stroke: comparison of noncontrast CT, CT angiography source images, and CT perfusion

BACKGROUND AND PURPOSE: The Alberta Stroke Program Early CT Score (ASPECTS) is a reliable method of delineating the extent of middle cerebral artery (MCA) stroke. Our aim was to retrospectively compare the accuracy of ASPECTS on noncontrast CT, CT angiography (CTA) source images, and CT perfusion maps of cerebral blood volume (CBV) during the first 3 hours of middle cerebral artery (MCA) stroke.MATERIALS AND METHODS: First-time patients with MCA stroke who presented <3 hours from symptom onset and were evaluated by noncontrast CT/CTA/CT perfusion, had confirmed acute nonlacunar MCA infarct on diffusion-weighted MR imaging (DWI) within 7 days, and had follow-up angiography were included. Patients were excluded for persistent MCA occlusion or stenosis. Two raters through consensus assigned an ASPECTS on the noncontrast CT, CTA source images, and the section-selective (2 × 12 mm coverage) CT perfusion CBV maps. ASPECTS on follow-up DWI served as the reference standard. For each CT technique, the detection rates of regional infarction, the mean ASPECTS, and the linear correlation to final ASPECTS were determined and compared. P values <.05 were considered significant.RESULTS: Twenty-eight patients satisfied the criteria with DWI performed at a mean of 50.3 hours (range, 22–125 hours) post-CT imaging. Of 280 ASPECTS regions, 100 were infarcted on DWI. The accuracy of noncontrast CT, CTA source images, and CT perfusion CBV for detecting regional infarct was 80.0%, 84.3%, and 96.8%, respectively (P < .0001). The mean ASPECTSs of noncontrast CT, CTA source images, CT perfusion CBV, and DWI were 8.4 ± 1.8, 8.0 ± 1.8, 6.8 ± 1.9, and 6.5 ± 1.8, respectively. The mean noncontrast CT and CTA source image ASPECTS was different from that of DWI (P < .05). Correlation of noncontrast CT, CTA source images, and CT perfusion CBV ASPECTS with final ASPECTS was r² = 0.34, r² = 0.42, and r² = 0.91, respectively.CONCLUSION: In a retrospective cohort of MCA infarcts imaged <3 hours from stroke onset, ASPECTS was most accurately determined on CT perfusion CBV maps.

The Alberta Stroke Program Early CT Score (ASPECTS) is a semiquantitative method of defining infarct extent in the middle cerebral artery (MCA) territory that is more reliable than the “1/3 MCA” rule^1,2 and is highly predictive of outcome.^3-6 ASPECTS was designed for conventional noncontrast CT, the ubiquitously performed imaging technique for triaging acute stroke. However, several recent studies have reported application of ASPECTS to CT angiography (CTA) source images^7-9 and CT perfusion parametric color maps,^10-12 with data to suggest that the acute ASPECTS is more accurately determined on these advanced CT techniques. Our aim was to retrospectively compare the accuracy and strength of the correlation of the acute ASPECTSs obtained on noncontrast CT, CTA source images, and CT perfusion mapping of cerebral blood volume (CBV) for nonlacunar MCA territory strokes imaged during the initial 3 hours of symptom onset. We hypothesized that with arterial recanalization, the CT perfusion CBV map is the best predictor of the final ASPECTS.     

Papel del estudio radiológico multimodal en el código ictus

In stroke code patients, multimodal imaging workup encompasses various imaging techniques, including baseline computed tomography (CT), magnetic resonance (MR) imaging, diffusion MR imaging, CT or MR perfusion studies, and CT or MR angiography, that are used to rule out bleeding, confirm arterial occlusion, establish tissue viability, and help select candidates for endovascular treatment as early as possible. Five recently published relevant clinical trials have demonstrated the efficacy of mechanical thrombectomy in proximal arterial occlusions; all these trials used different imaging techniques to select patients. Analyzing these trials and the scientific literature, we conclude that conventional CT interpreted with the Alberta Stroke Programme Computed Tomography Score (ASPECTS) and CT or MR angiography should always be used (level of evidence I, grade of recommendation A) and that CT and MR perfusion studies are useful in specific circumstances.     

Suspected early or mild chronic pancreatitis: enhancement patterns on gadolinium chelate dynamic MRI. Magnetic resonance imaging

PURPOSE: To assess whether measuring the pattern of pancreatic enhancement on gadolinium chelate dynamic magnetic resonance imaging (MRI) is helpful for diagnosis of suspected early or mild chronic pancreatitis. MATERIALS AND METHODS: In this retrospective study, 24 patients with suspected early or mild chronic pancreatitis, classified by imaging criteria of equivocal chronic pancreatitis (ultrasound, computed tomography [CT] or ERCP) grading, had dynamic MRI that included unenhanced, arterial dominant, early venous, and late venous phases of contrast enhancement. Twenty patients without pancreatic diseases also had the dynamic sequence as a control group. The signal intensity was measured at the pancreatic head, body, and tail on all phases, and for each, the signal intensity ratio (SIR, the signal intensity in postcontrast divided by that in precontrast) was calculated. Two radiologists independently reviewed the images of the patients with suspected early or mild chronic pancreatitis for pancreatic morphologic abnormalities without knowing the results of signal intensity measurements. RESULTS: On unenhanced images, there was no significant difference of signal intensity between control and pancreatitis groups (P < 0.05). In the pancreatitis group, but not in the control group, the unenhanced signal intensity of the pancreatic head and body were significantly higher than that of the tail (P < 0.05). In the control group, the greatest enhancement (highest SIR) after injection was in the arterial phase (1.89 +/- 0.31), significantly higher than that in the early venous phase (1.68 +/- 0.17, P < 0.01) and in the late venous phase (1.61 +/- 0.15, P < 0.001). The pancreatitis group, however, had an arterial phase SIR (1.65 +/- 0.23) that was significantly lower than its early venous phase SIR (1.75 +/- 0.22, P < 0.05) and lower than the arterial phase SIR of the control group (P < 0.01). The presence of an SIR less than 1.73 in the arterial phase and/or a delayed peak enhancement after contrast agent administration had a sensitivity and specificity of diagnosing early or mild chronic pancreatitis of 92% and 75%, respectively. This sensitivity was significantly higher than the sensitivity of 50% for diagnosis based on morphologic abnormalities (P < 0.05). CONCLUSION: Measuring pancreatic signal intensity on gadolinium chelate dynamic MRI is helpful for diagnosing early or mild chronic pancreatitis, especially before apparent pancreatic morphologic or signal intensity changes are present.     

超急性期及急性期脑梗死全脑CT灌注和CT血管造影研究

目的评价全脑CT灌注成像加同步CT血管造影(CTA)对早期缺血性脑梗死的诊断价值。方法对20例缺血性卒中发作2~24h病例分别行常规非强化CT(NCCT),CT全脑灌注成像(PWCT)及灌注后70s的延时扫描(DCT),分别测量低灌注区中心,周边及健侧相对应区CT值,计算病变中央和对侧灌注血液容积(PBV),PWCT作为CTA源图像重建CTA,判断颅内大血管阻断或狭窄及分支缺损情况,灌注延时相了解侧支循环改变,PWCT用密度差法处理,1周至1个月后复查CT、MR确定最终梗死区面积,用SPSS软件统计分析。结果20例缺血性卒中NCCT+PWCT+CTA未发现异常10例,其中临床及复查CT、MR证实短暂性脑缺血发作(TIA)6例,腔隙性梗死4例,10例PWCT低灌注区中心、周边内侧与外侧和健侧对应区CT值比较差异具有统计学意义(P<0·01),而病灶中心、周边内和外之间差异无统计学意义(P>0·05),病变侧和健侧PBV值差异有统计学意义(P<0·05),所有最终梗死区面积较低灌注区增大,增大百分比与缺血时间呈中度负相关,R2=0·42,CTA显示左大脑中动脉阻断2例,左大脑中动脉前、中分支缺如3例,NCCT、PWCT及CTA的敏感度分别为28·5%、71·4%和35·7%,延时相显示不对称充盈血管5例。结论CT全脑灌注像加同步CTA对早期脑梗死的诊断不失为一种简便、省时和有效的方法,可明确低灌注区的存在及其大小、位置和相对应供血动脉的情况,对半暗带区也可作出一定程度的推测,可为临床早期溶栓治疗提供半定量的形态学依据。     

肺腺癌的能谱CT参数与肿瘤浸润性及 Ki-67表达的相关性研究

目的：探究能谱CT成像参数与肺腺癌病理上的浸润性及Ki-67表达的相关性。材料与方法：收集我院2016年3月至2017年 7月经手术病理证实为肺腺癌患者的资料,共计60例,免疫组化均包含Ki-67,术前均已行宝石能谱成像（Gemstone spectral imaging,GSI）扫描。其中纯磨玻璃结节（pGGN）15例、混合磨玻璃结节（mGGN）组15例、实性结节组30例,采用spearman相关分析分别比较三组结节动、静脉期IC和Ki-67抗原表达的相关性。其中30例磨玻璃结节（GGN）分为A组,包括浸润前病变（2例）和微浸润腺癌（14例）,共计16例;B组为浸润性腺癌,共计14例。比较两组腺癌动、静脉期IC和Ki-67抗原表达的差异。结果：所有病例中,动、静脉期IC和Ki-67抗原表达呈负相关（r1=-0.749,P1=0.000;r2=-0.624,P2=0.000）;pGGN组动、静脉期IC和Ki-67抗原表达无相关性（P＞0.05）;mGGN组和实性结节组的动、静脉期IC和Ki-67抗原表达呈负相关（r1=-0.754、-0.617 ,P1＜0.05;r2=-6.09、-0.460,P2=＜0.05）。A组Ki-67抗原表达小于B组（P=0.001）,两组动、静脉IC的差异无统计学意义。结论：肺腺癌能谱CT相关参数和KI-67抗原表达有显著的负相关性,在评估肿瘤增殖能力方面具有潜在的价值,但在诊断GGN浸润程度的作用还有待进一步研究论证。     

CT Angiography ASPECTS Predicts Outcome Much Better Than Noncontrast CT in Patients with Stroke Treated Endovascularly

BACKGROUND AND PURPOSE:Noncontrast CT ASPECTS has been investigated as a predictor of outcome in patients with acute ischemic stroke. Our purpose was to investigate whether CTA source images are a better predictor of clinical and radiologic outcomes than NCCT ASPECTS in candidates for endovascular stroke therapy.MATERIALS AND METHODS:CT scans of patients (n = 124) were independently evaluated by 2 readers for baseline NCCT and CTA source image ASPECTS and for follow-up ASPECTS. An mRS of ≤2 at 3 months was considered a favorable outcome. Receiver operating characteristic curve analysis was used to assess the ability of NCCT and CTA source image ASPECTS to identify patients with favorable outcomes. A stepwise multiple regression analysis was performed to find independent predictors of outcome.RESULTS:Baseline CTA source image ASPECTS correlated better than NCCT ASPECTS with follow-up ASPECTS (r = 0.76 versus r = 0.51; P for comparison of the 2 coefficients < .001). Receiver operating characteristic curve analysis showed that baseline CTA source image ASPECTS compared with NCCT ASPECTS can better identify patients with favorable outcome (CTA source image area under the curve = 0.83; 95% CI, 0.76–0.91; NCCT area under the curve = 0.67; 95% CI, 0.58–0.77; P < .001). Finally, the stepwise regression analysis showed that lower age, good recanalization, lower time to recanalization, and good baseline CTA source image ASPECTS, not NCCT ASPECTS, were independent predictors of favorable outcome.CONCLUSIONS:CTA source image ASPECTS predicts outcome better than NCCT ASPECTS; this finding suggests CTA rather than NCCT as a main step in the decision-making process for patients with acute ischemic stroke.

The Alberta Stroke Program Early CT Score merges the ability of quantifying and describing the topography of brain tissue damage produced by acute ischemic stroke in a semiquantitative way.¹ ASPECTS on noncontrast CT is widely used for the assessment of early ischemic changes, and its prognostic value has already been established,² though with poor NCCT sensitivity.³ Recent randomized controlled trials on endovascular stroke therapy (ET) have been based on strict inclusion criteria, leading to treatment of only those patients with high CT ASPECTS indicating smaller infarct burden.^4–6Many attempts have been made to understand which patients are likely to undergo futile reperfusion.⁷ For instance, it has been recently demonstrated that patients with poor collaterals and longer time to reperfusion do not achieve good outcomes after ET.⁸ Thus, a careful patient selection for ET should be desirable and should be based on a multimodal neuroimaging approach in addition to onset time and stroke severity. Although not as commonly available as NCCT in the acute ischemic stroke setting, CT angiography is useful for confirmation of vessel occlusion in candidates for ET, and hypodensity on CTA source images (CTA-SI) has been shown to reliably correlate with ischemic lesion volume on diffusion-weighted imaging⁹ and final infarct size.¹⁰ The superiority of CTA-SI on NCCT in the detection of infarcted areas has been demonstrated for readers of all levels of experience.¹¹ Few data exist on the value of CTA-SI ASPECTS in patients undergoing ET for acute ischemic stroke,^12,13 and this lack of data may explain why only ASPECTS NCCT is currently considered in the guidelines for eligibility for ET. Our purpose was to investigate whether CTA-SI ASPECTS correlate better than NCCT ASPECTS with clinical and radiologic outcome measures in patients with acute ischemic stroke undergoing ET.