64层螺旋CT多参数扫描评价急性缺血性脑卒中的研究

目的 探讨多参数CT合理的扫描及后处理技术即PBV在评价缺血性脑卒中的应用价值.方法 72例0～9 h发病患者,分别行CT平扫及CTA检查.使用三维Neuro PBV软件处理CTA图像获得全脑血流灌注图(PBV),以PBV结果指导CT灌注(CTP)扫描.CT检查完毕后6 h内行MR检查.分别计算梗塞灶数目同时测量CTP、PBV与DWI图像梗塞体积.比较多参数CT扫描与MR梗塞灶的数目及梗塞体积.结果 入选患者中,多参数CT与MR发现病灶的数目分别为102、110个;二者之间的Kappa分析结果为0.78.CTP、PBV与MR检测体积配对t检验结果分别为t=7.249,P>0.05;t=11.390,P>0.05.结论 CT多参数扫描较为全面地反映脑缺血病灶的范围及血管情况,在早期诊断脑缺血中具有重要价值.     

CT脑灌注成像在短暂性脑缺血发作的初步研究

目的　探讨CT脑灌注成像在短暂性脑缺血发作 (TIA)的应用。方法　对 5例正常人及2 0例临床诊断TIA的病人行常规CT头颅平扫及CT脑灌注成像。在常规轴面CT扫描后一般选取基底节层面 ,经肘静脉团注对比剂 ,同时开始持续 40s的单层连续动态扫描 ,重建的 40幅动态图像使用CT脑灌注软件包进行处理 ,获得灌注图像。测量脑内感兴趣区的到达峰值时间及血流量 ,对这些图像进行定量分析。结果　CT脑灌注成像显示脑灰质灌注高于脑白质。正常人脑灰质的血流量及达峰时间分别为 378 2ml·min-1·L-1、7 8s ;脑白质分别为 112 5ml·min-1·L-1、9 9s。 2 0例TIA患者中有 15例发现与临床症状相对应的灌注异常区 ,表现为达峰时间延迟 ;另外 5例未发现灌注异常区。2 0例患者患侧局部灌注达峰时间 (TP)延长及对侧的平均达峰时间分别为 (11 8± 4 4)s和 (9 1±3 1)s,经配对t检验 :t=5 2 77,P <0 0 1;脑血流值分别为 (2 2 3 5± 38 7)ml·min-1·L-1和 (2 2 9 1±41 4)ml·min-1·L-1,经配对t检验 ;t=1 892 ,P =0 0 74。结论　CT脑灌注成像能够为TIA患者提供有价值的脑血流动力学信息 ,显示灌注异常的范围。     

64层螺旋CT三维脑灌注血容量在急性缺血性梗死中的应用

目的探讨以CT血管成像(CTA)为基础的三维CT全脑灌注血容量(3D PBV)影像在急性脑缺血中的应用价值。方法38例0～12h发病病人,分别行CT平扫及CTA扫描。使用三维Neuro PBV软件处理CTA获得全脑血流灌注影像。CT检查完毕后2h内行MRI检查。分别用MRI、3D PBV、CT平扫计算梗死灶数目同时测量3D PBV与扩散加权成像(DWI)中梗死体积。分别比较平扫CT、3D PBV、MRI的梗死灶数目及测量3D PBV和MRI的梗死体积。结果38例入选病人中,MRI、3D PBV、CT平扫发现病灶的数目分别为45、41、16个;三者的Kappa分析结果κ值分别为0.24、0.18、0.78。3D PBV与MRI检测体积配对t检验结果为t=7.249,P0.05。结论3D PBV结合CTA可以较为全面地反映脑缺血病灶的范围及血管情况,在早期诊断脑缺血中具有重要价值。     

CT脑灌注成像结合CTA对脑梗死前期诊断的研究

目的 探讨64层容积CT脑灌注成像结合头颈部血管成像对脑梗死前期诊断的临床应用价值.资料与方法 对45例临床诊断为急性缺血性脑血管病而常规CT平扫未发现异常的病例进行脑灌注成像及头颈部血管成像检查.测量脑内感兴趣区(region of interest,ROI)的局部脑血流量(regional cerebral blood flow,rCBF)、局部脑血容量(regional cerebral blood volume,rCBV)、平均通过时间(mean transit time,MTT)、最大峰值时间(time to peak,TTP),并根据脑梗死前期的分期标准进行分析;对颈部及颅内病变血管按照北美症状性颈动脉内膜切除术试验(NASCET)标准计算狭窄率.结果 发现脑灌注异常42例,其中Ⅰ_1,期6例、Ⅰ_2期16例、Ⅱ_1期12例、Ⅱ_2期8例,其中7例同时有两个部位发现异常灌注区,分别处于Ⅰ_2期和Ⅱ_1期,3例未发现异常灌注区.患侧TTP、MTT与对侧镜像比较差异有统计学意义.45例行CTA检查,发现60支颈内动脉狭窄,24支椎动脉狭窄,27例颅内动脉血管不同程度狭窄,各期患者分布情况与相应供血动脉狭窄程度呈正相关.结论 64层容积CT脑灌注成像结合头颈部血管成像能清楚显示脑梗死前期的血流动力学异常及相应的血管狭窄程度,具有重要的临床应用价值.     

CT脑灌注与血管造影在急性脑梗死中的临床应用

目的:探讨64层螺旋CT脑灌注成像和脑血管造影技术在急性期脑梗死中的应用价值。方法:应用PhilipsBrilliance CT 64,对30例发病12h内急性脑缺血患者行CT平扫、CT脑灌注成像(CTP)和CT血管造影(CTA)检查。分析平扫及灌注成像表现,计算出缺血区脑血流参数,包括:脑血容量图(CBV)、血流量图(CBF)、对比剂平均通过时间(MTT)和对比剂峰值时间(TTP),与对侧相应区灌注参数进行比较,并重建颈段和脑内动脉CTA图像。所有病例在发病后3~14天复查CT平扫。结果:30例患者中16例头颅平扫发现早期脑梗死征象,14例常规平扫未发现异常,而CTP均发现灌注异常区。CTP表现为CBF及CBV减低、MTT及TTP延迟;患侧CBF、MTT、TTP与对侧差异有显著性意义(P<0.01),患侧CBV与对侧差异无显著性意义(P>0.01)。重建CTA图像显示16例一侧颈内动脉狭窄,8例一侧大脑中动脉狭窄(其中1例伴大脑后动脉狭窄、左侧后交通动脉闭塞);4例左侧大脑中动脉闭塞,2例左侧颈内动脉闭塞。结论:CTP能够早期、及时、准确地反映缺血部位及程度,预测半暗带;CTA可以显示病变血管的部位和程度;联合应用两者,对早期诊断急性脑缺血和指导治疗有重要价值。     

CT脑灌注成像在超急性期脑梗死中的应用

CT脑灌注成像(CTP)可以显示脑血流动力学信息,早期即可显示缺血的梗死灶和缺血性半暗带,预测可以存活的脑组织,对早期诊断和治疗脑梗死及判断预后具有重要价值。随着64层螺旋CT的广泛应用,明显缩短了扫描时间,CT平扫、CTP和CT血管造影(CTangiography,CTA)联合扫描20min内即可完成,而且利用CTA和平扫图像获得三维脑灌注血容量(perfused blood volume,PBV)成像,可以全面显示病灶范围,避免小病灶的漏诊。     

动态灌注技术CTP联合头颈部血管造影CTA在基层医院急性缺血性脑卒中评估中的价值

目的探讨动态灌注技术联合头颈部血管造影在基层医院急性缺血性脑卒中评估中的价值。方法选取2019年5月~2020年6月我院临床接诊怀疑急性脑卒中的患者125例,所有患者均经过常规CT平扫、动态灌注技术CTP联合头颈部血管造影CTA检查,比较CTA及CTP联合CTA两种诊断方法的灵敏度、特异度及准确度,分析梗塞灶核心梗死区及缺血半暗带的灌注参数,分析缺血性脑卒中与头颈部血管狭窄的相关性,评价CTP及CTA图像质量。结果CTP联合CTA的诊断灵敏度、特异度及准确度均高于CTA的诊断灵敏度、特异度及准确度(P<0.05),核心梗死区及缺血半暗带与健侧镜像区灌注参数CBF、CBV、MTT和TTP的差异均有统计学意义。缺血性脑卒中与颈内动脉狭窄程度没有相关性,与颅内动脉狭窄程度中等强度相关。CTP及CTA图像质量均可达到诊断要求。结论动态灌注技术联合头颈部血管造影能够对急性缺血性脑卒中的供血动脉及血流灌注进行有效评估,在基层医院为早期临床诊断提供部分客观依据。     

脑CT灌注成像和血管成像术在海岛医院中的应用价值

目的探讨海岛医院应用CT灌注成像（CT perfusion imaging，CTPI）和CT血管成像（CT angiography，CTA）对超早期脑梗死诊断的应用价值。方法采用四排螺旋CT对24例突发偏瘫或失语、发病时间少于6h、CT检查阴性的患者，即行CTPI和CTA检查，定量分析病灶侧灰质区及皮层区的脑血流量（cerbral blood flow，CBF）、脑血容量（cerebral blood volume，CBV）、达峰时间（time to peak，TTP），并与对侧相应部位进行比较。在第2天及第7天行CT及MRI复查，对照观察CTPI和CTA的诊断价值。结果24例入选病例中4例CTA检查诊断为短暂性脑缺血发作（transient ischemic attack，TIA），其余20例中右侧颈内动脉段梗塞3例，右侧大脑中动脉主干支梗塞4例，右侧大脑中动脉分支梗塞8例，左侧大脑中动脉主干支梗塞3例，左侧大脑中动脉分支梗塞1例，左大脑后动脉主干支梗塞1例。上述病例在第2天、第7天在CT或MRI检查中均被证实，诊断符合率100％。脑梗死（cerebral infarction，CI）患侧的灰质CBF、灰质与白质CBV明显低于对侧（均P〈0．05）。CI组患侧脑白质区及灰质区的CBV明显低于TIA组（均P〈0．05）。结论联合进行头颅CT平扫、CTPI和CTA检查，有助于临床超早期识别CI、TIA；患侧脑白质区及灰质区的CBV状态是识别CI较为敏感的指标；CTA图像能敏感反映是否存在血管阻塞，是区分TIA与CI的可靠指标。     

64层CT灌注成像对短暂性脑缺血发作患者的血流动力学评价

目的:探讨64层CT灌注(64-SCTP)成像对评价短暂性脑缺血发作(TIA)患者脑血流动力学变化的价值.材料和方法:对20例临床诊断为TIA的患者行64-SCTP检查及头颈部64层CT血管造影(64-SCTA)检查,其中,前循环TIA 11例,后循环TIA 9例,测定兴趣区及对侧相应区域局部脑血流量(rCBF)、局部脑血容量(rCBV)、平均通过时间(MTT)和达峰时间(TTP),评价TIA患者脑血流动力学变化.结果:20例患者头颅CT平扫均未发现与临床症状相对应的病灶,CTP有13例CT脑灌注成像发现与临床症状相对应的异常灌注区,其中10例前循环TIA患者发现灌注异常区,TTP、rCBF、MTT值与健侧对照区差异均有显著性意义(P<0.05),rCBV与健侧对照区差异均无显著意义(P>0.05);3例后循环TIA患者发现枕叶有灌注异常;CTA发现10例前循环血管狭窄,6例后循环血管狭窄;结论:脑64-SCTP成像可以用于评价TIA患者血流动力学改变;脑64-SCTP结合头颈部CTA对TIA病因诊断及病情评估有着重要的临床价值.     

64层螺旋CT三维脑灌注血容量在急性缺血性梗死中的应用

目的探讨以CT血管成像（CTA）为基础的三维CT全脑灌注血容量（3D PBV）影像在急性脑缺血中的应用价值。方法38例0～12h发病病人,分别行CT平扫及CTA扫描。使用三维Neuro PBV软件处理CTA获得全脑血流灌注影像。CT检查完毕后2h内行MRI检查。分别用MRI、3D PBV、CT平扫计算梗死灶数目同时测量3D PBV与扩散加权成像（DWI）中梗死体积。分别比较平扫CT、3D PBV、MRI的梗死灶数目及测量3D PBV和MRI的梗死体积。结果38例入选病人中,MRI、3D PBV、CT平扫发现病灶的数目分别为45、41、16个;三者的Kappa分析结果κ值分别为0.24、0.18、0.78。3D PBV与MRI检测体积配对t检验结果为t=7.249,P〉0.05。结论3D PBV结合CTA可以较为全面地反映脑缺血病灶的范围及血管情况,在早期诊断脑缺血中具有重要价值。     

多模式CT预测评估缺血性卒中患者血脑屏障完整性和侧支循环的价值分析

目的探讨多模式CT对评估缺血性卒中患者血脑屏障完整性和侧支循环的价值。方法选取我院收治的确诊为缺血性卒中的患者76例,行多模式CT检查,包括CT平扫(NCCT)、CT灌注成像(CTP)及CT血管成像(CTA)等模式。分析灌注范围的分布并绘制感兴趣区(ROI),测定脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)及表面通透性(PS)等灌注指标。结果1)依据侧支循环分组,良好组患者的CBV、CBF、MTT明显高于不良组(P<0.05)。良好组患者末次随访时的梗死范围、mRS评分明显低于不良组(P<0.05);2)依据出血性转化分组,HT组的PS明显高于未HT组,而MTT明显低于未HT组,两组比较差异有统计学意义(P<0.05)。结论对于脑血管狭窄及侧支循环的建立,多模式CT可观察侧支循环的建立或开放状况,预测缺血性卒中预后水平,可评估血脑屏障(blood brain barrier,BBB)的完整性及HT的发生风险,对临床治疗有指导意义。     

Color-coded perfused blood volume imaging using multidetector CT: initial results of whole-brain perfusion analysis in acute cerebral ischemia

Computed tomography (CT) is still the primary imaging modality following acute stroke. To evaluate a prototype of software for the calculation of color-coded whole-brain perfused blood volume (PBV) images from CT angiography (CTA) and nonenhanced CT (NECT) scans, we studied 14 patients with suspected acute ischemia of the anterior cerebral circulation. PBV calculations were performed retrospectively. The detection rate of ischemic changes in the PBV images was compared with NECT. The volume of ischemic changes in PBV was correlated with the infarct volume on follow-up examination taking potential vessel recanalization into account. PBV demonstrated ischemic changes in 12/12 patients with proven infarction and was superior to NECT (8/12) in the detection of early ischemia. Moreover, PBV demonstrated the best correlation coefficient with the follow-up infarct volume (Pearson’s R = 0.957; P = 0.003) for patients with proven recanalization of initially occluded cerebral arteries. In summary, PBV appears to be more accurate in the detection of early infarction compared to NECT and mainly visualizes the irreversibly damaged ischemic tissue. Stephan P. Kloska and Tobias Fischer contributed equally to this work.     

256层螺旋CT全脑灌注联合CTA在急性脑梗死诊断中的价值

目的 探讨256层MSCT全脑CTP与CTA技术相结合在急性脑梗死中的应用价值,并评估脑梗死与供血动脉状况的关系.方法 对21例临床拟诊急性脑梗死患者行常规CT平扫、CTP和CTA检查,重建并分析CT平扫图像、CTP及CTA图像,所有病例在CTP检查后24h内进行MRI＋ DWI检查.结果 21例脑梗死患者CTA发现33条动脉不同程度狭窄及闭塞,其中包括轻度狭窄4例,中度狭窄13例,重度狭窄7例,闭塞9例.21例患者CTP发现32处梗死灶,脑梗死中心区及周边区rCBF下降、TTP延长的差异在统计学上有显著性意义.结论 256层螺旋CT全脑CTP联合CTA扫描方法简便,可对缺血后脑组织供血动脉状况及血流动力学改变进行有效评价.     

Perfusion CT and angio CT in the assessment of acute stroke

In order to evaluate the clinical utility of non-enhanced CT with perfusion and angio CT in the assessment of acute ischaemic stroke, 42 patients with symptoms of acute stroke were examined within the first 6 h from onset of symptoms with non-enhanced CT (NECT), perfusion CT (PCT) and CT angiography (CTA). Maps of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were analysed visually, and after drawing regions of interest (ROIs) in the territory of anterior, middle and posterior cerebral arteries, maximum-intensity projection and volume-rendering images of the cervical and cerebral vessels were created. All patients underwent a control CT or MR examination 24–48 h after the initial examination. Twenty-nine patients developed an area of infarction at control examinations. Significant perfusion abnormalities were found in 27 cases, whilst in two patients the perfusion studies were considered to be normal. All the cases with perfusion abnormalities showed arterial stenoses or occlusions on angio CT. Small infarctions at levels other than the ones selected for perfusion CT, and arteriosclerotic changes, were observed in the two cases with no perfusion abnormalities. In conclusion, combining non-enhanced CT with PCT and CTA is a simple and a very valuable tool in the initial assessment of acute stroke.     

多层螺旋CT脑灌注成像与血管成像联合评价颈动脉狭窄与脑梗死的临床研究

目的 应用多层螺旋CT灌注成像与CTA联合评价颈内动脉狭窄与脑梗塞的相关性.资料与方法 59例急性脑梗死患者,在急性发作后6 h内行CT灌注成像和CTA检查.通过CTA对颈动脉狭窄程度进行评估,通过灌注图像评估脑梗塞的血流动力学状态.结果 梗死侧颈动脉血管狭窄发生率显著高于非梗死侧(P＝0.001),颈动脉狭窄程度与脑梗死所致神经功能缺损的严重程度之间明显相关(P<0.05).结论 联合CT灌注与CTA能评价颈内动脉狭窄程度与脑组织的血流灌注情况之间的关系.     

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...     

64层螺旋CT脑灌注成像评价急性脑梗死溶栓前后脑血流动力学改变

目的探讨64层螺旋CT脑灌注成像(CTP)在评价急性脑梗死溶栓疗效中的应用价值。资料与方法20例急性脑梗死患者于发病3~10h行常规CT平扫和CTP检查,其中16例行静脉溶栓、4例行动脉溶栓治疗。溶栓后2~7天复查CT平扫和CTP。对溶栓治疗前后病变区的脑血流量(CBF)、脑血容量(CBV)和达峰时间(TTP)进行定性和定量比较分析。结果20例中5例头颅CT平扫发现早期脑梗死征象,15例常规CT平扫未发现异常,CTP均发现与临床症状对应的脑灌注异常区,表现为CBF、CBV降低,TTP延迟。溶栓后15例脑灌注异常范围缩小,CBF和CBV增加,TTP缩短;3例脑灌注异常区范围扩大,CBF、CBV进一步降低,TTP延迟更加显著;2例出现局部过度灌注。统计学分析结果显示溶栓治疗后多数患者脑灌注情况明显改善,缺血边缘区CBF和TTP与溶栓前差异有统计学意义(P<0.05),缺血中心区CBF和CBV与溶栓前差异无统计学意义(P>0.05)。结论脑CTP检查能够观察溶栓治疗前后脑血流动力学指标的变化,为评价急性脑梗死患者的溶栓疗效提供重要依据。     

双源CT双能量肺灌注成像对肺栓塞的诊断和临床应用价值

目的:探讨双源CT双能量肺灌注成像对肺动脉栓塞的诊断和临床应用价值。方法:对疑诊肺动脉栓塞的78名患者行双源CT肺动脉成像双能量扫描,数据经后处理得到肺动脉血管图像(CTA)和肺灌注图像(PBV)。两位医师对PBV图像进行质量评价和分型,同时观察CTA图像有无栓塞以及栓塞的部位、程度。分析PBV图像的表现与CTA图像、肺部异常改变的关系。用Kappa系数检验两位观察者对PBV图像质量评价和分型的一致性,计算PBV图像诊断肺栓塞的敏感度、特异度、阳性预测值和阴性预测值。结果:两位医师对肺灌注图像质量的分级以及肺灌注图像的分型一致性极强,K值分别为0.87、0.80,P值均<0.01。PBV图像诊断肺栓塞的敏感度为95.30%,特异度为56.40%,阳性预测值为70.70%,阴性预测值为91.20%。对于完全栓塞的患者,其敏感度和特异度均为100%。结论:双源CT双能量肺灌注成像能够显示肺动脉栓塞导致肺血流改变的肺灌注异常。     

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.