64层螺旋CT脑灌注成像评价急性脑梗死溶栓前后脑血流动力学改变

目的探讨64层螺旋CT脑灌注成像(CTP)在评价急性脑梗死溶栓疗效中的应用价值。资料与方法20例急性脑梗死患者于发病3~10h行常规CT平扫和CTP检查,其中16例行静脉溶栓、4例行动脉溶栓治疗。溶栓后2~7天复查CT平扫和CTP。对溶栓治疗前后病变区的脑血流量(CBF)、脑血容量(CBV)和达峰时间(TTP)进行定性和定量比较分析。结果20例中5例头颅CT平扫发现早期脑梗死征象,15例常规CT平扫未发现异常,CTP均发现与临床症状对应的脑灌注异常区,表现为CBF、CBV降低,TTP延迟。溶栓后15例脑灌注异常范围缩小,CBF和CBV增加,TTP缩短;3例脑灌注异常区范围扩大,CBF、CBV进一步降低,TTP延迟更加显著;2例出现局部过度灌注。统计学分析结果显示溶栓治疗后多数患者脑灌注情况明显改善,缺血边缘区CBF和TTP与溶栓前差异有统计学意义(P<0.05),缺血中心区CBF和CBV与溶栓前差异无统计学意义(P>0.05)。结论脑CTP检查能够观察溶栓治疗前后脑血流动力学指标的变化,为评价急性脑梗死患者的溶栓疗效提供重要依据。

64 slice Spiral CT Cerebral Perfusion Imaging for Evaluation of Cerebral Hemodynamics Before and After Thrombolytic Therapy in Acute Cerebral Infarction

Objective To explore the value of 64-slice spiral CT cerebral perfusion imaging (CTP) in evaluating the thrombolytic therapy in patients with acute cerebral infarction. Materials and Methods Conventional plain CT and CTP were performed on 20 patients with acute cerebral infarction within 3 to 10 hours after onset of symptom. 16 patients underwent intravenous thrombolysis and 4 patients underwent intra-arterial thrombolysis. All patients were reexamined cerebral plain CT and CTP after thrombolysis. Qualitative and quantitative analysis of the cerebral perfusion parameters such as cerebral blood flow (CBF) ,cerebral blood volume (CBV) and time to peak (TTP) were carried out on CTP images before and after thrombolytic therapy. Results Results of conventional plain CT were normal in 15 cases and early infarction signs were showed in 5 cases. However, abnormal perfusion changes corresponding to clinical symptoms were all found in 20 cases, including CBF and CBV decreased, TTP delayed. Follow-up CTP showed that the cerebral perfusion improved in 15 cases after thrombolysis, including the extent of abnormal perfusion reduced, CBF and CBV increased, TTP was delayed. The hyperperfusion of ischemic lesion was observed in 2 cases. The extent of abnormal perfusion expanded, CBF and CBV decreased, TTP delayed even more than those before thrombolysis were found in 3 cases. There was statistically significant difference between the CBF and TTP on ischemic marginal region before and after thrombolysis (P<0.05). However, there was no statistically significant difference between the CBF and CBV on ischemic central region before and after thrombolysis (P>0.05). Conclusion64-slice spiral CTP can depict detailed hemodynamic information before and after thrombolysis, and provide important basis for evaluating the effect of thrombolytic therapy in patients with acute cerebral infarction.