早期CT灌注成像参数与急性脑梗死脑血管异常及其预后的关系  

Relationship between Early CT Perfusion Imaging Parameters and Cerebral Vascular Abnormalities and Clinical Prognosis of Patients with Acute Cerebral Infarction

作　　者：杨林[1] 杨克[2] 周德伟[3] 刘羽 刘雪茹 

机构地区：[1]四川省资阳市第一人民医院影像科,四川资阳641300 [2]陕西省西安市第一医院麻醉科,陕西西安710002 [3]四川省资阳市第一人民医院放射科,四川资阳641300 [4]西南医科大学附属医院麻醉科,四川泸州646000

出　　处：《现代生物医学进展》2017年第34期6740-6744,共5页Progress in Modern Biomedicine

摘　　要：目的:探讨急性脑梗死患者的血管异常情况和CT灌注成像参数及其临床预后的关系。方法:将我院自2013年11月至2016年11月收治的6h内颈动脉系统发病的急性脑梗死患者85例作为研究对象,进行CT灌注成像以及血管造影等检查,并记录各项参数,评价病侧大血管的情况,在发病时、发病2周以及3个月时采用NIHSS量表评价患者神经功能缺损程度。结果:有11例患者在出现症状后6h内完成检测,74例患者在出现症状后6-24小时完成检测。CTP对脑梗死的检出率明显高于CT平扫。半影区和梗死区r CBF、r CBV和MTT与对照区比较差异具有统计学意义(P<0.05)。CTA检测显示血管正常者25例、血管狭窄者45例、血管闭塞者15例;在发病时、发病14 d、发病90 d时,血管狭窄者和血管闭塞者的NIHSS均高于血管正常者,差异具有统计学意义(P<0.05)。血管狭窄者和血管闭塞者发病时BI均低于血管正常者,差异具有统计学意义(P<0.05)。在发病14d时血管闭塞者BI低于血管狭窄者和血管正常者,而m RS高于血管狭窄者和血管正常者,差异具有统计学意义(P<0.05)。三组随着发病时间的增加,NIHSS和m RS均具有下降趋势,BI有上升的趋势。结论:早期CT灌注成像参数水平可准确地显示是否存在缺血半暗带,通过定量分析灌注参数对比病灶和健侧的血流灌注状态有助于判断患者预后。Objective： To explore the relationship between vascular abnormalities in patients with acute cerebral infarction and CT perfusion imaging parameters and clinical prognosis. Methods： Eighty-five patients with acute cerebral infarction who were admitted to our hospital from November 2013 to November 2016 were enrolled in the study. CT perfusion imaging and angiography were performed. The severity ofneurologic impairment was assessed by NIHSS at 2 weeks and 3 months after the onset of the disease. Results： 11 cases of patients had completed the dectection in 6h after onset of symptoms, and 74 cases of patients had completed the dectection in 6-24h after onset of symptoms. The detection rate of cerebral infarction used by CTP was significantly higher than that used by CT plain scanning. The rCBF, rCBV and MTT of penumbra area and infarction area were significantly different from those in control group （P〈0.05）; CTA test showed that there were 25 cases of vascular normal, 45 cases of vascular stenosis, 15 cases of vascular occlusion. On the 14th day and 90th day of onset, the NIHSS of patients with vascular stenosis and vascular occlusion were higher than those of patients with normal blood vessels （P〈0.05）. At the time of onset, the BI of patients with vascular stenosis and vascular occlusion were lower than those of patients with normal blood vessels （P〈0.05）. On the 14th of onset, the BI of patients with vascular occlusion were lower than those of patients with vascular stenosis and normal blood vessels. While the mRS was higher than that of patients with vascular stenosis and normal blood vessels （P〈0.05）. With the increase of onset time in the three groups, the NIHSS and mRS all decreased, while BI showed escalating trend. Conclusion： The level of early CT perfusion imaging parameters can display accurately whether exist ischemic penumbra, it contributes to judge the prognosis of patients by analyzing quantificationally perfusion parameters to compare the focus and contralateral bl

关 键 词：急性脑梗死 脑血管异常 CT灌注成像 临床预后 

分 类 号：R743[医药卫生—神经病学与精神病学]