64排螺旋CT脑灌注成像联合头颈部血管成像在急性脑梗死中的应用  

Study on acute cerebral infarction by CT perfusion and CT angiography with 64-detector row CT

作　　者：朱建国[1] 杨亚芳[1] 刘斐[1] 唐继来[1] 沈世田[1] 顾生荣[1] 万谦[1] 史永平[1] 朱成红[1] 

机构地区：[1]南京医科大学第二附属医院医学影像科

出　　处：《医学研究生学报》2012年第11期1182-1185,共4页Journal of Medical Postgraduates

摘　　要：目的常规CT检查难以获得脑梗死的血流动力学信息,CT灌注成像可反映脑梗死患者脑组织血流异常灌注情况。文中探讨联合应用CT灌注成像(CT perfusion imaging,CTP)和CT血管成像(CT angiography,CTA)对急性脑梗死的诊断价值。方法对38例临床疑为急性脑梗死的患者进行脑CTP联合头颈部CTA扫描检查,用CT灌注软件和血管软件进行评估。结果梗死区与对侧脑区相比,灌注值(perfusion)、强化峰值(peak enhancement,PE)、达峰值时间(time to peak,TTP)差异有统计学意义。脑血容量(cerebral blood volume,CBV)值差异无统计学意义;相对灌注值(relative perfusion,rP)、相对脑血容量(relative CBV,rCBV)呈下降趋势。梗死区TTP值显著延长。CTA显示38例患者中8例(21.1%)病灶侧大血管大致正常,12例(31.6%)发现病灶侧大脑中动脉狭窄、闭塞;5例(13.2%)病灶侧大脑前动脉狭窄、闭塞;5例(13.2%)病灶侧大脑后动脉狭窄、闭塞;8例(21.1%)病灶侧颈内动脉狭窄、闭塞。所有病例均未发现颅内动脉瘤、血管畸形、颅内占位病变。结论 CTP及CTA联合检查具有快捷、经济的特点,可同时观察急性脑梗死血液动力学改变并分析病变区供血动脉情况,为临床诊断和治疗提供更多病理生理学信息。Objective The hemodynamic information of patients with cerebral infarction can′t be demonstrated by normal CT easily.While,CT perfusion imaging can demonstrate the changes.The purpose of this study was to investigate the value of the combined application of CT perfusion（CTP） and CT angiography（CTA） in the diagnosis of acute cerebral infarction（ACI）.MethodsThirty-eight patients suspected of ACI underwent CTP and CTA.All the data were subjected to 3D postprocessing,VR reconstruction and CT perfusion package analyses.Results Statistically significant differences were observed in the perfusion,peace enhancement（PE） and time-to-peak（TTP） values,but not in the cerebral blood volume（CBV）,between the infarcted area and the contralateral brain region.Relative perfusion（rPerfusion） and relative CBV（rCBV） were decreased and the TTP value significantly extended.CTA revealed generally normal ipsilateral vessel in 8 cases（21.1%）,ipsilateral middle cerebral artery stenosis or occlusion in 12（31.6%）,anterior or posterior cerebral artery lesion in 5（13.2%）,and internal carotid artery stenosis or occlusion in 8（21.1%）.Intracranial aneurysm,vascular malformation and intracranial lesion were found in none of the 38 cases.Conclusion Combined application of CTP and CTA,with its advantages of being fast and economical,can demonstrate at once the hemodynamic changes and the morphology of the vessels in ACI patients,providing valuable pathophysiological information for clinical diagnosis and therapy.

关 键 词：CT灌注成像 CT血管成像 急性脑梗死 

分 类 号：R544[医药卫生—心血管疾病]