急性缺血性脑血管病76例多模式CT影像学分析  

Image performance of multimodal CT for acute ischemic cerebrovascular disease in 76 patients

作　　者：韩玺河[1] 车丽红[2] 邹梅[1] 郭淼[1] 王琳琳[1] 刘学玲[1] 钟玲[1] 肖艳[1] 刘燕[1] 李燕云[1] 张晓莺[1] HAN Xi-he;CHE Li-hong;ZOU Mei;GUO Miao;WANG Lin-lin;LIU Xue-ling;ZHONG Ling;XIAO Yan;LIU Yan;LI Yan-yun;ZHANG Xiao-Ying(Departent of Neurology, the Bingtuan Hospital of Xinjiang, Urumqi 830002, China)

机构地区：[1]新疆生产建设兵团医院神经内科,乌鲁木齐830002 [2]新疆生产建设兵团医院消化科,乌鲁木齐830002

出　　处：《脑与神经疾病杂志》2017年第3期141-145,共5页Journal of Brain and Nervous Diseases

基　　金：兵团科技攻关计划(2012AB016)

摘　　要：目的探讨76例急性缺血性脑血管病(AICVD)的多模式CT影像学特点。方法采用320排多层螺旋CT对76例AICVD(发病时间<24h)患者急诊进行CT平扫(NCCT)+CT灌注成像(CTP)+CT血管成像(CTA)一站式扫描检查,分析灌注区脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)等灌注参数变化及CT血管成像(CTA),并于入院后3d内行头颅MRI,评估其脑灌注特点及血管影像。结果在获取的76例CTP数据中,通过感兴趣区识别划分筛查,有59例患者有明确的异常CTP,有17例患者未发现明确感兴趣区。59例异常CTP中包括急性脑梗死47例,短暂性脑缺血发作(TIA)12例。急性脑梗死患者异常CTP特点:发病在4.5h以内的4例患者CTP表现为患侧CBF均较健侧下降,CBV正常或者轻度增高,MTT、TTP延长;发病时间在4.5~6h内的4例:其中2例CTP表现为CBF降低,CBV正常,MTT、TTP延长,2例表现为CBF降低,CBV轻度降低,MTT、TTP延长;发病时间在6~24h内的39例:其中30例梗死区与CTP异常脑灌注区部位一致,均表现CBF明显降低,CBV明显降低,MTT、TTP延长;12例TIA患者CTP均发现与临床症状相对应的灌注异常:MTT、TTP延长,CBF正常或减低,CBV升高。CTA发现责任动脉重度狭窄5例,血管闭塞10例,7例可见血流缓慢,排空延迟及侧支血管形成。结论多模式CT能够对AICVD提供血流灌注参数的变化及血管情况、供血区的血流动力学变化,对临床诊治具有一定参考价值,主要用于评估大脑半球卒中,多模式CT有临床价值。Objective To analyze the image performance of multimodal CT for acute ischemiccerebrovascular disease(AICVD)in76patients.Method76patients with AICVD underwent one-stop CT andCTP-CTA of internal carotid system.The parameter maps of cereabral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT)and time to peak(TTP)were analyzed.meanwile dynamic CT angiography(CTA)images were obtained.MRI was performed within3days of admission.Results In the image of CT perfusion for76patients,to analyzed region of interest,59cases were found abnormal region of interest and17cases were not found.Include47cases acute cerebral infarction and12TIA in59patients,the characteristic image of abnormal CTP:4patients in4.5hours:including decrease in CBF and normal in CBV,prolonged in TTP and MTT of2patinets,another2patients showed decrease in CBF and reduce in CBV,prolonged in TTP and MTT;in4.5-6h of4patients:includingdecrease in CBF and normal in CBV,prolonged in TTP and MTT of2patinets,another2patients showed decreasein CBF and CBV,prolonged in TTP and MTT;in6-24h of39patients:abnormal perfusion region same as cerebra infarction of30patients:obvious decrease in CBF and CBV,prolonged in TTP and MTT.abnormal perfusion regionconform with clinical responsibility focus in12patients of TIA:prolonged in TTP and MTT,normal or decrease inCBF,increase in CBV;CTA demonstrated vascular stenosis in5cases and occlusion in10cases.7of them with visiblecollateral vessel formation had small finalinfarct.Conclusion Multimodal CT can show changes of cerebral bloodflow parameters and the degree of stenosis of the corresponding the feeding artery in AICVD.Has certain referencevalue to the clinical diagnosis and treatment,multimodal CT mainly apply in the cerebral hemisphere stroke,especiallywith clinical value.

关 键 词：多模式CT 急性缺血性脑血管病 影像学特点 

分 类 号：R743.32[医药卫生—神经病学与精神病学]