64层螺旋CT脑灌注联合CT血管造影在超早期脑梗死患者的应用

目的评价64层螺旋CT脑灌注成像(CTP)联合CT血管造影(CTA)对超早期脑梗死的应用价值。方法对30例超早期脑梗死患者,均于发病6 h内行CT平扫、CTP及CTA检查,分析平扫及灌注成像表现,测量缺血区的脑灌注参数值,并重建颈段和脑内动脉CTA图像。结果30例患者中10例头颅CT平扫发现早期脑梗死征象,20例常规CT平扫未发现异常,CTP均发现灌注异常区。CTP表现为脑血流量及脑血容量减低、达峰时间延迟;梗死区的脑血流量、脑血容量与对侧差异有显著性意义(P<0．01),半暗带区脑血流量、达峰时间与对侧差异有显著性意义(P<0．01),而脑血容量差异无显著性意义(P<0．05)。重建CTA图像显示17例脑梗死患者一侧大脑中动脉重度狭窄或闭塞,13例一侧颈内动脉重度狭窄或闭塞。结论CTP能够早期快速、准确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,对早期诊断缺血性脑卒中和指导治疗有重要价值。

Application of 64 multislice spiral CT cerebral perfusion imaging and CT angiography in patients with hyperacute stroke

Objective To evaluate the application of 64 multislice spiral CT cerebral perfusion imaging (CTP) and CT angiography(CTA) in patients with hyperacute stroke. Methods Conventional cerebral plain CT, CTP and CTA were performed in 30 patients with hyperacute ischemic stroke within 6 hours of onset of symptom . All cases were reexamined by cerebral plain CT after 2 to 14 days. Dynamic CTP images were processed with the "CT Perfusion" software package on workstation. Quantitative analysis of cerebral perfusion parameters were performed on CTP images. CT angiography was reconstructed to show carotid and intracerebral artery. Results Conventional plain CT of the 30 cases found no abnormality in 20 cases and early infarction signs in 10 cases. However,abnormal perfusion changes corresponding to clinical symptoms were found in all 30 cases, including decrease in cerebral blood flow(CBF) and cerebral blood volume (CBV), delayed time to peak (TTP) . There were significant differences of CBF, CBV and TTP between infarction side and contralateral side (P <0.01). CTA demonstrated stenosis or occlusion of middle cerebral artery and internal carotid artery in 30 cases. Conclusion CTP can early show the ischemic extent and penumbra and CTA can show the stenosis or occlusion of artery in patients with hyperacute stroke.