全脑CT灌注参数快速评价脑梗死核心及缺血半暗带

目的 探讨全脑CT灌注(CTP)参数 快速评价脑梗死核心和缺血半暗带的方法。方法 对31例疑似急性缺血性卒中(AIS)患者行全脑 CTP联合头颈部CTA检查,获得CBF和MTT及头颈部CTA图。CTP检查结束3天内行头颅MR检查。观察梗死核心在CBF及DWI图像的部位、数量、面积;测量梗死核心、缺血半暗带及各自镜像区的CBF和MTT,计算相对CBF(rCBF)、相对MTT(rMTT)。结果 31例疑似脑梗死患者,CBF共检出24例33个梗死灶,10例存在缺血半暗带。MRI共检出26例97个梗死灶。CBF及DWI测量梗死核心区面积相关性良好(r=0.98,P=0.07)。脑缺血半暗带区CBF为(6.79±1.29)ml/(100 g·min),MTT为(17.07±3.13)s,rCBF为0.71±0.09,rMTT为1.53±0.19。结论 选择MTT延长区与CBF明显减低不匹配区可较快速、准确地检出缺血半暗带。诊断患者有无脑梗死时,CBF与DWI具有良好的一致性,但CBF不能取代DWI进行脑梗灶数量的诊断。

Whole brain CT perfusion in fast assessment of infarct core and ischemic penumbra

Objective To investigate a fast way to access infarct core and ischemic penumbra by using whole brain CT perfusion (CTP) parameters, including cerebral blood flow (CBF), mean transit time (MTT) and their relative values (rCBF and rMTT). Methods Thirty-one cases of suspected acute ischemic stroke underwent CTP combined with head and neck CTA. The CBF, MTT and CTA maps were obtained. All of patients underwent MRI in 3 days after CTP. The size, location and the number of infarct core were observed in CBF and DWI. The value of CBF, MTT and their relative values in infarct core, ischemic penumbra and their contralaterals were recorded. Results Of all the 31 cases, 24 cases of 33 lesions were diagnosed by CBF, 10 cases were diagnosed as ischemic penumbra; 26 cases of 97 lesions were diagnosed by DWI. The positive correlation of area of infarction in DWI and CBF was found (r=0.98, P=0.07). The CBF, MTT, rCBF and rMTT of ischemic penumbra were (6.79±1.29)ml/(100 g·min), (17.07±3.13)s, 0.71±0.09, 1.53±0.19. Conclusion The ischemic penumbra can be diagnosed rapidly and accurately when MTT prolonged and CBF reduced. The CBF has a good consistence in diagnosing infarction with DWI, but CBF cannot take place of DWI in diagnosing the number of infarct lesions.