CT脑灌注与血管造影在急性脑梗死中的临床应用  

The study of 64 multislice-spiral CT cerebral perfusion imaging and CT angiography in acute cerebral infarction

作　　者：戎倩雯[1] 王嵩[1] 石璐[1] 王一凡[1] 

机构地区：[1]上海中医药大学附属龙华医院放射科,上海200032

出　　处：《医学影像学杂志》2011年第3期313-316,共4页Journal of Medical Imaging

摘　　要：目的：探讨64层螺旋CT脑灌注成像和脑血管造影技术在急性期脑梗死中的应用价值。方法：应用PhilipsBrilliance CT 64,对30例发病12h内急性脑缺血患者行CT平扫、CT脑灌注成像（CTP）和CT血管造影（CTA）检查。分析平扫及灌注成像表现,计算出缺血区脑血流参数,包括：脑血容量图（CBV）、血流量图（CBF）、对比剂平均通过时间（MTT）和对比剂峰值时间（TTP）,与对侧相应区灌注参数进行比较,并重建颈段和脑内动脉CTA图像。所有病例在发病后3~14天复查CT平扫。结果：30例患者中16例头颅平扫发现早期脑梗死征象,14例常规平扫未发现异常,而CTP均发现灌注异常区。CTP表现为CBF及CBV减低、MTT及TTP延迟;患侧CBF、MTT、TTP与对侧差异有显著性意义（P〈0.01）,患侧CBV与对侧差异无显著性意义（P〉0.01）。重建CTA图像显示16例一侧颈内动脉狭窄,8例一侧大脑中动脉狭窄（其中1例伴大脑后动脉狭窄、左侧后交通动脉闭塞）;4例左侧大脑中动脉闭塞,2例左侧颈内动脉闭塞。结论：CTP能够早期、及时、准确地反映缺血部位及程度,预测半暗带;CTA可以显示病变血管的部位和程度;联合应用两者,对早期诊断急性脑缺血和指导治疗有重要价值。Objective：To evaluate the value of 64 multislice-spiral CT cerebral perfusion imaging（CTP） in acute cerebral infarction.Methods：Conventional plain CT and CTP were performed on 30 patients with acute cerebral ischemia within 12 hours of onset of symptom by Philips 64-spiral CT scanner,head and neck angiography in 72 hours.These dynamic images were processed with software package on workstation,perfusion parameters of region cerebral blood volume（CBV）,region cerebral blood flow（CBF） were calculated,mean transonit time（MTT） and time to peak（TTP） were measured and the parameters were compared with the opposite sides of brain regions in correspondent.CT angiography was constructed to show carotid and intracerebral arteries.All patients were re-examined cerebral plain CT after 3~14 days.Results：Conventional plain CT of the 30 cases found no abnormality in 14 cases and early infarction signs in 16 cases.However,abnormal perfusion changes corresponding to clinical symptoms were found in all 30 cases,including decrease in cerebral blood flow（CBF） and cerebral blood volume（CBV）,delayed time to peak（TTP） and mean transit time（MTT）.There were significant differences of CBF,MTT and between infarction side and contralateral side（P0.01）.There were no significant differences of CBV（P0.01）.CTA demonstrated stenosis or occlusion of middle cerebral artery and internal carotid artery in 30 cases.Conclusion：CTP can early show the ischemic extent and penumbra.CTA can show the stenosis or occlusion of artery in patients with acute cerebral infarction.The combination of the two examinations can give important information for diagnosis of acute cerebral infarction.

关 键 词：急性脑梗死 CT脑灌注 体层摄影术 X线计算机 

分 类 号：R743[医药卫生—神经病学与精神病学] R814.42[医药卫生—临床医学]