CT灌注成像应用于早期缺血性脑血管病的相关研究

目的探讨CT灌注成像（CTPI）对早期缺血性脑血管病的应用价值。方法45例早期急性缺血性脑血管患者中（发病时间≤24h），行头部常规CT平扫后，立即行CTPI及TCD检查，24-72h后复查颅脑CT。对所得灌注扫描源数据用Adw 4.2软件行后处理得CT灌注参数图并进行诊断，最后对灌注及CT、TCD结果进行分析并行统计学处理。结果CT平扫：敏感度44.44%，特异度68.97%。CTPI：敏感度91.11%，特异度95.35%。TCD：敏感度71.11%。四格表χ2检验证明CTPI较CT平扫、TCD检出早期脑内缺血病灶均敏感（χ2=9.257，χ2=5.874，P〈0.01）；而单纯TCD检查与CT平扫对检出早期脑内缺血病灶无明显差异（χ2=0.458，P〉0.05）。结论脑CT灌注成像的敏感度、特异度及诊断率均明显高于CT及TCD，能很好地评价脑血流动力学改变，准确显示缺血脑组织的部位和范围，可早期诊断急性缺血性脑梗死，并评价其血流灌注情况，为临床早期诊断、预防及治疗脑梗死提供影像学依据，同时对于早期选择治疗方案、指导临床有重要意义。

A study on CT perfusion imaging in early ischemic cerebrovascular disease

Objective To explore the clinical value of CT perfusion imaging in early ischemic cerebraovascular disease. Methods 45 patients with early acute ischemic cerebrovascular disease （onset within 24 hours） were enrolled in this study, including 29 males and 16 females with age of 50 - 78 years （the average age is 62.3）. After CT scanning on head, the CT-perfusion imaging and TCD examination were immediately followed, and the craniocerebral CT was then reviewed 24h - 72h afterwards. The source data of perfusion imaging was processed by Adw4.2 software to obtain the CT-perfusion parameter diagram and carry out the diagnosis, The results of perfusion, CT and TCD were analyzed statistically. Results In the CT scan, the sensitivity and specificity were 44.44% and 68.97%, respectively; in the CTPI, the sensitivity and specificity were 91.11% and 95.35%, respectively; in TCD, the sensitivity however, was 71.11%. The analysis of four tables test showed significant superiority in CTPI comparedto routine CT and TCD scan （ χ2=9. 257, 2 =5. 874, P〈0.01）. Pure TCD examination and CT scan in detecting early brain ischemia lesions, however, had no obvious difference （ χ2=0. 458, P 0.05）. Conclusions The sensitivity, specificity and diagnosis rate of brain CT perfusion imaging were obviously better than CT and TCD, it can be very good to evaluate the changes of brain hemodynamic, show the position and scope of brain ischemia tissue accurately, diagnose acute ischemic cerebral infarction and evaluate its blood perfusion at early stage, provide the imaging basis for clinical diagnosis, prevention and treatment of cerebral infarction. Furthermore, it has also shown a significant value in choosing treatment for this disease at early stage.