64层螺旋CT灌注成像联合血管成像在急性缺血性脑卒中的应用价值

目的探讨脑容积CT灌注成像(CT perfusion imaging,CTPI)与头颅CT血管成像(CT angiography,CTA)联合应用在急性缺血性脑卒中的应用价值。方法对22例临床有神经缺失症状的患者,发病24 h内行64层螺旋CTPI和CTA后,选定感兴趣区层面,测量异常灌注区和对侧脑组织血流动力学参数。结果22例患者CTPI发现病灶区域灌注异常的敏感性为90.1%,特异性为100%;脑血流量减低、平均通过时间延长;灌注异常区与对照区域差异有显著性意义(P<0.01)。64层螺旋CT可同时获得容积CTPI和包括颅底动脉环在内的CTA;22例患者均发现有不同程度的低灌注区,有19例患者CTA发现血管异常。结论早期、特别是超早期缺血性脑卒中患者CTPI结合CTA检查,对病因、病情进展、预后评估、半暗带区判定提供了综合、简单、快速、便捷的影像学依据。

The value of 64-slice spiral CT perfusion imaging and CT angiography in acute ischemic stroke

Objective To evaluate the value of combined use of CT perfusion(CTP) imaging and CT angiography(CTA) in acute ischemic stroke.Methods Twenty-two acute ischemic stroke patients were included. The regions of interest(ROI) of the patients were selected within 24 hours of onset by 64-slice spiral CT.rCBV,rCBF,MTT and TTP were used as hemodynamic parameters to compare research regions with the counterparts.Specificity and sensitivity of the CTP and CTA were analyzed with gold standard of MRI results.The differences of MTT,CBF,CBV and TTP between the affected cores and supposed penumbra were also analyzed.Results CBF of the research area reduced,and MTT increased.Matched-sample t test of interest area and control area showed P<0.01.Sensitivity of CTP plus CTA in identifying ischemic area was 90.1% and the specificity was 100%.Conclusion CTPI plus CTA may provide radiological evidence in predicting development,severity,prognosis of acute ischemic stroke patients.