急诊多参数CT用于预测急性脑梗死的最终梗死体积  

Application of emergency multiple parameter CT in predicting final infarction volume following acute ischemic stroke

作　　者：谢容霞 陈辉[1] 刘楠[1] 张微微[1] 朱光明[1] 

机构地区：[1]北京军区总医院神经内科,100700 [2]河北省廊坊长征医院神经内科

出　　处：《中华老年心脑血管病杂志》2014年第12期1260-1264,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的 探讨常规CT、CT血管造影（CTA）和CT灌注（PCT）等多参数CT预测急性脑梗死患者最终脑梗死体积的价值.方法 回顾性分析107例急性前循环脑梗死患者的临床资料.利用多参数CT评估脑梗死体积、缺血半暗带体积及血管再通情况,测量3～6个月的最终脑梗死体积.进行3次多因素线性回归分析,判定影像参数与临床预后的相关性.结果 107例患者中,常规CT提示大脑中动脉高密度征阳性71例,早期脑卒中CT评分（8.0±1.7）分;CT血管造影显示平均颈动脉狭窄程度（36.3±43.8）％,PCT计算脑梗死体积（36.3±43.8）ml,半暗带体积（40.5±26.2） ml,总缺血体积为（69.2±26.1）ml.3次多因素线性回归模型能预测最终脑梗死体积（R1 =0.542,P1 =0.009;R2=0.494,P2=0.004;R3 =0.494,P3=0.004）.血管再通时PCT中脑梗死和缺血半暗带、颈内动脉狭窄程度和侧支循环评分是最终脑梗死体积的独立预测因素（P=0.000,P=0.000,P=0.004）.结论 脑卒中超早期的影像评估应包括有灌注信息的多参数CT,以尽早获取血管再通及半暗带体积,指导临床治疗.Objective To study the value of conventional CT,CT angiography and perfusion CT in predicting the final infarction volume following AIS.Methods The clinical data of 107 patients with anterior circulation AIS were retrospectively analyzed.Cerebral infarction volume,penumbra and revasculization were assessed according to their multiple parameter CT findings.Final infarction volume for 3-6 months were measured.Correlation between multiple parameter CT findings and clinical outcome was analyzed by multivariate linear regression analysis.Results Conventional CT showed positive cerebral middle artery high density in 71 out of the 107 anterior circulation AIS patients with a CT score of 8.0± 1.7 for early ischemic stroke,and perfusion CT displayed that the infarction volume was 36.3 ±43.8 ml,the ischemic penumbra was 40.5 ± 26.2 ml,and the total ischemic volume was 69.2±26.1 ml,indicating that the 3 kinds of CT can predict the final infarction volume（R1 =0.542,P1 =0.009 ; R2 =0.494,P2 =0.004 ; R3 =0.494,P3 =0.004）.Cerebral infarction lesion,ischemic penumbra,carotid stenosis severity and collateral flow score were the independent predictors of final infarction volume（P=0.05）.Conclusion Early assessment of ischemic stroke should include the perfusion information of multiple parameter CT in order to achieve revascularization and show the penumbra,which contributes to the clinical treatment of anterior circulation AIS.

关 键 词：脑梗死 体层摄影术 X线计算机 颈动脉狭窄 侧支循环 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]