急性脑缺血介入治疗前后多层螺旋CT灌注成像的对照研究

目的探讨多层螺旋CT灌注成像（MSCTP）在评价急性脑缺血介入治疗前后血流动力学改变的作用。方法对48例急性脑缺血患者介入治疗前后分别行MSCTP检查，获得脑血流量（CBF）、脑血容量（CBV）及平均通过时间（MTT），计算出缺血边缘区和缺血中央区的RCBF、RCBV和RMTT值（病变侧与镜像的对侧相应值的比值），分析其介入治疗前后的变化。结果介入治疗后缺血边缘区的RCBF值显著增加（P〈0．01），RMTT值显著减小（P〈0．05），RCBV值无显著性增加（P〉0．05）。而缺血中心区的RCBF和RCBV为轻度增加（P〉0．05），RMTT值轻度减小（P〉0．05）。48例患者介入治疗前MSCTP均发现与临床症状相对应的脑灌注异常区。介入治疗后MSCTP患者异常灌注有改善者32例，明显改善者12例，无改善者3例，进一步加重者1例。结论MSCTP可以较好地反映急性脑缺血介入治疗前后的血流动力学状况，有利于疗效的评价。

A Comparative Study with Multi-Slice CT Perfusion Imaging:Before And After Interventional Therapy in Acute Cerebral Ischemia

Objective To evaluate the role of multi-slice CT perfusion（MSCTP） in monitoring hemodynamic changes in the patients with acute cerebral ischemia before and after interventional therapy. Methods 48 patients with acute cerebral ischemia were included in this prospective study. MSCTP was performed before and after interventional therapy during the injection of 50 ml of contrast material. Perfusion coverage was adjusted according to vascular territory of interest. Mean cerebral blood volume （ CBV）, cerebral blood flow （CBF）, mean transit time （MTT） were calculated for different vascular territories in both hemisphere,and so the CBF ratios （RCBF ）, CBV ratios （ RCBV ） and MTT ratios （ RMTT ） on ischemic marginal region and ischemic central region. Results The RCBFwas increased significantly on ischemic marginal region after interventional therapy（ P 〈 0. 01 ）, the RMTT significant difference （ P 〈 0.05 ）, and the RCBV no significant difference （ P 〉 0.05 ）. The RCBFRMTT and RCBV all showed no significant difference on ischemic central region after interventional therapy （P 〉 0.05 ）. All patients had a baseline perfusion abnormality. 32 of 48 cases showed improved perfusion after interventional therapy, 12 cases improved obviously, 3 cases no improved obviously and 1 case aggravated. Conclusion MSCTP is a new method to evaluate hemodynamic changes in patients with acute cerebral ischemia before and after interventional therapy, provide particular informations about effect evaluation.