64层螺旋CT脑灌注联合CT血管造影在短暂性脑缺血发作的应用

目的评价64层螺旋CT脑灌注成像(CTP)联合CT血管造影(CTA)对短暂性脑缺血发作(TIA)的应用价值。方法对36例临床诊断TIA的患者行常规头颅CT平扫、CTP及CTA检查,分析平扫及灌注成像表现,测量脑内感兴趣区的灌注参数值,并重建颈段和脑内动脉CTA图像。结果36例TIA患者中有26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10例未发现灌注异常区。26例患者病变侧及对侧的达峰时间分别为(12．04±4．05)s和(9．89±2．68)s,经配对t检验差异有显著性意义(P＜0．01);病变侧脑血流量值较对侧略低,脑血容量值较对侧略高,但差异无显著性意义。重建CTA图像显示26例患者大脑中动脉或颈内动脉狭窄或闭塞。结论头颅CT平扫可排除其他脑内疾病,CTP提供脑血流动力学信息,CTA可明确血管有无狭窄,对TIA的诊断有重要意义。

The application of 64 multislice spiral CT cerebral perfusion imaging and CT angiography in patients with TIA

Objective To evaluate the application of 64 multislice spiral CT cerebral perfusion imaging(CTP) and CT angiography(CTA)in patients with transient ischemie attacks(TIA).Methods Conventional cerebral plain CT,CTP and CTA were performed on 36 patients with TIA.After regular plain CT examination,dynamic CTP was performed while 40ml of non-ionic contrast material were bolus injected through antecubital vein. These dynamic images were processed with the“Perfusion CT”software package on workstation.Cerebral blood flow(CBF),cerebral blood volume(CBV)and time to peak(TIP)enhancement within specific regions of the brain were measured.CT angiography was constructed to show carotid and intracerebral arteries,Results Abnormal perfusion changes corresponding to clinical symptoms were found in 26 cases with prolonged TTP. Other 10 cases were normal.TIP of affected side(12.04±4.05)s was significantly prolonged compared with contralateral side(9.89±2.68)s, P＜0.01.The differences of the CBF and CBV were not statistically sig- nificant between affected side and contralateral side.CTA demonstrated stenosis or occlusion of middle cerebral artery or internal carotid artery in 26 cases with prolonged TTP.Conclusion Plain CT can exclude other in- tracerebral diseases,CTP provides hemodynamie information and CTA demonstrates presence or not of artery stenosis or occlusion.The combination of these three examinations can give information for diagnosis of TIA.