脑梗死早期局部自发性血流再灌注全脑CT灌注成像表现  

Early spontaneous reperfusion in patients with acute or subacute infarction:the whole brain CT perfusion images findings

作　　者：魏新华[1] 杨蕊梦[1] 郭媛[1] 徐宏刚[1] 郭永梅[1] 黄云海[1] 徐向东[1] 梁志伟[1] 吴梅[1] 江新青[1] 

机构地区：[1]广州医学院附属广州市第一人民医院放射科,广东广州510180

出　　处：《医学影像学杂志》2012年第12期1974-1977,共4页Journal of Medical Imaging

摘　　要：目的探讨全脑CT灌注成像(CTPI)对发现缺血性脑卒中早期局部自发性再灌注现象的价值。方法回顾分析110例急性期和亚急性早期(6h～10天)缺血性脑卒中患者临床资料及全脑CTPI参数图〔脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)、达峰时间(TTP)和延迟(Delay)图〕。以患者未接受静脉或动脉溶栓治疗,并且首次CT-PI显示梗死脑区CBV减低、复查CTPI显示梗死脑区CBV为正常或增高定义为自发性再灌注区,分别观察各灌注参数图的特点并测量再灌注区和对侧镜像正常脑区各灌注参数值,采用配对t检验比较再灌注区与对侧正常脑区灌注参数值的差异。结果共有15例存在自发性再灌注现象,距发病平均时间为61.5h,自发性再灌注脑区表现为CBV/CBF增高、TTP延长(P<0.05)。结论全脑CTPI能可靠发现脑梗死早期自发性再灌注现象,为临床治疗提供重要信息。Objective To demonstrate the imaging findings of regional spontaneous reperfusion using whole brain CT perfusion images （CTPI） in patients with acute or early subacute infarction. Methods The CTPI data of 110 patients with acute or early subacute infarction （6 h~ 10 d）were analyzed retrospectively, ai,d the parameter maps of CTPI including cerebral blood value （CBV）, cerebral blood flow （CBF）, mean transit time （MTT）, time to peak （TTP） and delay maps were generated in the off-line workstation using specific software. The reperfusion areas on the parameter maps defined as normal or increased CBV in the fellow up CTPI but with decreased CBV in the first exam of CTPI, and all the patients did not received thrombolysis therapy. The reperfusion areas were determined by two radiologists with 8 years of experience in diagnostic radiology. The values of CTPI parameters were measured by placing region of interest （ROI） in ipsilateral le- sions and contralateral mirror areas in CTPI maps. Paired t-test was used to compare the values of reperfusion areas with contralateral normal areas in CTP maps. Results Fifteen of 110 patients with ischemic stroke were found with spontane- ous reperfusion areas in the infarction lesions. The mean onset time of patients was 61.5 h. Compared with contralateral brain areas, the reperfusion areas showed increased values of CBV, CBF and TTP （ P 〈0.05）. Conclusion Whole brain CTPI is a reliable technique in detecting reperfusion phenomenon in ischemic stroke patients in the early stage.

关 键 词：脑梗死 灌注成像 再灌注 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]