双排螺旋CT脑灌注成像在超早期脑梗死诊断中的价值

目的　探讨双排螺旋CT脑灌注成像技术在超早期脑梗死诊断中的意义。　方法　 对18例短暂性脑缺血发作患者行头部CT平扫,选择基底核区或感兴趣区行CT脑灌注成像,获 取脑血流量(CBF)、脑血容量(CBV)和对比剂平均通过时间(MTT)图;出院时复查CT,与 入院时CT片比较。对同一例患者脑灌注后资料作统计学分析。　结果　患者发病90min后,CT 脑灌注即可显示出病灶区域血流灌注异常,与对侧相比CBF、CBV下降,MTT延长。对于CT平 扫未见病灶的患者,可预示有无梗死灶的存在、位置及范围;对于已有梗死灶的患者可预示病灶 的发展趋势。12例CT脑灌注异常的同一例患者,左、右两侧半球脑实质内CBF、CBV及MTT差 异均具有显著意义(P<0.05～0.01),6例无CT脑灌注异常者,差异无显著意义(P>0.05～ 0.01)。　结论　CT脑灌注成像技术可超早期预示脑梗死病灶及其发展趋势,有重要的临床应用 价值。统计学分析可作为诊断脑血流灌注异常的一种补充。

The diagnostic value of CT perfusion imaging for detection of hyperacute cerebral infarction

objective To evaluate the diagnostic value of CT perfusion imaging for detection of hyperacute cerebral infarction. Methods Routine CT was performed in 18 patients with cerebral hypoperfusion, then CT perfusion imaging study was made by selecting the basal ganglia slice and adjacent slice of interest of the brain. Cerebral blood follow(CBF), cerebral blood volume(CBV), and mean transit time(MTT) were measured. The routine CT scan was performed again when the patients leaved hospital and the result of CT was compared with that when admitted to the hospital. These cerebral perfusion data of the two cerebral hemisphere in same patient was analyzed using statistics. Results The cerebral perfusion abnormality could be found within 90 minutes after symptom onset. The stages of hyperacute infarction were made according to the following criterion: CBF and CBV were decreased, and MTT was delayed. The perfusion imaging could be used to detect the location and size of hyperacute cerebral infarction and it could not be found by nonenhanced CT scan the perfusion CT also could be used to predict the outcome of hyperacute infarction which had been found by nonenhanced CT. The statistics result showed: there was statistical significant difference of CBF, CBV, and MTT between the two cerebral hemisphere in 12 patients whom having the abnormity of cerebral perfusion (P < 0.05~0.01), while there was no significant difference in 6 patients whom having normal cerebral perfusion(P > 0.05~0.01). Conclusion The perfusion CT could be used to detect the location and predict the outcome of hyperacute cerebral stroke,hence it has important clinical value. The statistics analysis was a suppliment for diagnosis of hyperacute ischemic infarction.