CT灌注成像视觉评估在急性大脑中动脉脑梗死溶栓治疗中的指导作用  

The guiding role of visual evaluation of perfusion computed tomography in thrombolytic therapy for cerebral infarction in MCA territory

作　　者：李永秋[1] 刘娜[1] 李瑜霞[1] 

机构地区：[1]河北医科大学唐山临床学院神经内科,河北唐山063000

出　　处：《中风与神经疾病杂志》2007年第6期694-696,I0002,共4页Journal of Apoplexy and Nervous Diseases

摘　　要：目的试图确定大脑中动脉主干闭塞急性脑梗死患者就诊时即刻pCT参数图像视觉评估在指导溶栓治疗中的可行性。方法对符合溶栓治疗条件的大脑中动脉主干闭塞急性脑梗死患者首先进行NIHSS、pCT及CTA检查,随后给予rt-PA静脉溶栓治疗。24h～48h后复查CTA及CT,记录NIHSS评分,血管再通由CTA证实,分为血管再通组和血管未通组。手工测量pCT各参数图和最终脑梗死体积。结果溶栓后血管再通组溶栓前后NIHSS评分下降值明显低于血管未通组,经独立样本秩和检验P=0.0001<0.05。24h～48h后血管再通组最终梗死体积明显低于血管未通组,经独立样本秩和检验P=0.0008<0.05。首次NIHSS评分与TTP延长体积密切相关,血管再通组最终梗死体积与CBV下降体积密切相关,而血管未通组,最终梗死体积与TTP延长体积密切相关。将血管再通组首次pCT中TTP延长的体积减去CBV下降的体积,其差值与其溶栓前后NIHSS评分的差值具有相关性。结论TTP或MTT体积减去CBV下降体积约等于半暗带,半暗带的大小是决定是否可以进行溶栓治疗的客观指标。Objective To establish the validity of visual interpretation of immediately processed perfusion computed tomography（pCT） maps in acute ischemic stroke in middle cerebral artery territory for guiding thrombolytic therapy . Methods NIHSS score,perfusion CT scan and CT angiography were collected from patients with acute MCA territory infarction who fit thrombolytic therapy criteria as soon as possible from onset,then intravenous thrombolysis using rtPA was given according to the European product licence at the discretion of the responsible clinieian. A follow up NIHSS score,CT scan and CT angiography was done 24～48h after stroke onset. MCA patency at 24～48h was defined by CT angiography. The subjects were divided into recanalization group and occlusion group. Volumes of lesions were obtained by drawing manually around the margins of changed TTP, MTT,CBF and CBV on initial pCT. Regions of lesion were drawn around the final infarct on non-contrast computed tomography at 24～48h in order to derive final infarct volume. The sum of lesion areas was multiplied by slice thickness to derive lesion volumes. Results NIHSS score of recanalization group descend significantly than occlusion group ,P= 0. 0001 〈0.05. The final infarction volume of recanalization group was lower than oeclusion group, P=0. 0008〈0.05. Volume of tissue with prolonged TTP correlated with initial NIHSS,and with CT final infarct volume when arterial ocelusion persisted. Volume of tissue with reduced CBV correlated with final infarct volume if recanalisation occurred. The changes in NIHSS score from baseline to 24～48h was correlated with mismatch volume between initial TTP and CBV. Conclusion Mismatch volume between initial TTP and CBV means penumbra and the volume of penumbra determine whether thrombolytic therapy can be conducted.

关 键 词：急性大脑中动脉区脑梗死 CT 灌注成像 溶栓治疗 半暗带 CT血管成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学]