CT灌注成像对脑梗死缺血半暗带的动态观察  

Dynamic Investigation of Ischemic Penumbra in Ischemic Infarct with CT Perfusion Imaging

作　　者：马春[1] 余聪[1] 赵建农[1] 郭大静[1] 李杰[1] 罗银灯[1] 谢维波[1] 沈霞[1] 

机构地区：[1]重庆医科大学第二附属医院放射科,重庆市渝中区临江路74号400016

出　　处：《中国医学计算机成像杂志》2008年第3期195-199,共5页Chinese Computed Medical Imaging

基　　金：重庆市卫生局医学科学技术研究项目资助(编号06-2-073)~~

摘　　要：目的:应用CT灌注成像(CTPI)诊断超急性期脑梗死,并对缺血半暗带灌注情况进行动态观察。材料和方法:26例发病时间在6h内临床怀疑脑梗死的患者进行头颅CT平扫及CTPI检查,测量病变区及镜像侧脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)及各个参数图异常灌注区面积,并计算相对脑血流量(rCBF)、相对脑血容量(rCBV)、相对平均通过时间(rMTT)。第一次扫描24h后复查CT平扫及CTPI。结果:第一次CT平扫示非责任的陈旧性脑梗死6例,其余20例均未见异常。CTPI示超急性期脑梗死20例,其中16例存在缺血半暗带;其余6例为TIA。复查CTPI示超急性期存在缺血半暗带的16例病例于急性期梗死区周围仍然存在低灌注区,与超急性期半暗带rCBF、rCBV及rMTT比较无明显差异(t分别为2.05,1.515,0.081;P>0.05)。超急性期缺血半暗带区rCBF、rMTT与TIA低灌注区比较有明显差异(t分别为2.868,3.717;P<0.05),而rCBV比较无明显差异(t=1.748;P>0.05)。急性期梗死区面积平均1470.75mm^2较超急性期(1387mm^2)增大,梗死区面积增加与缺血半暗带所占比例有线性相关关系(spearman相关系数1.00,P<0.05)。结论:缺血半暗带不仅仅存在于脑梗死超急性期,在急性期亦可能有缺血半暗带的存在;CTPI不但能够早期诊断缺血性脑卒中,而且对不同发病时间病例是否存在缺血半暗带做出判断。Purpose： To diagnose hyperacute infarct and study hemodynamics of ischemic penumbra in hyperacute and acute infarct with CT perfusion imaging（CTPI） . Materials and Methods： 26 patients underwent conventional plain CT and CTPI, which were admitted within 6 hours of symptom onset. Cerebral blood fiow（CBF）、 cerebral blood volume（CBV） and mean transit time（MTT） of ipsilateral lesions and contralateral mirroring areas and area of abnormal perfusion in functional maps were measured, and relative CBF（rCBF）, relative CBV（rCBV）、 relative MTT（rMTT） were obtained. The same protocol was performed 24 hours after the first time examination. Results： Conventional plain CT demonstrated 6 cases with irresponsible infarct lesions, the rest 20 cases no abnormalities in the first time examination. TIA was found in 6 cases, and hyperacute infarct in 20 cases with CTPI, in which there were 16 cases with ischemic penumbra. Hypoperfusion around infarct also was figured out in 16 cases in the areas of ischemic penumbra in acute infarct.No significant difference was found in rCBF, rCBV 及 rMTT in ischemic penumbra between hyperacute and acute infarct （t = 2.05, 1. 515, 0. 081, respectively, P 〉 0.05）. There was significant difference in rCBF, rMTT between ischemic penumbra of hyperacute infarct and hypop- erfusion area of TIA（ t = 2. 868, 3. 717, respectively, P 〈 0.05）, however, no significant difference in rCBV （ t = 1. 748, P 〉 0.05） . The average area of infarct in acute infarct was 1470.75mm^2 that was larger than that（ 1387 mm^2） in hyperacute infarct. The extent of infarct growth had significantly correlation with initial proportions of ischemic penumbra in hypoperfusion（ r = 1.00, P 〈 0.05） . Conclusion： Ischemic penumbra was found not only in hyperacute infarct, but also might be found in acute infarct. CTPI could demonstrate accurately hyperacute ischemic infarct, and analyze whether or not there is ischemic penumbra and observe its development in different pha

关 键 词：灌注 脑缺血 脑梗死 体层摄影术 X线计算机 

分 类 号：R743.3[医药卫生—神经病学与精神病学]