4D-CTA联合CTP在缺血性脑卒中的应用  

Application of 4D-CTA Combined with CTP in the Diagnosis of Ischemic Stroke

作　　者：蔡培 徐凯 牛磊 袁璞[3] 王永康[2] 乔风雷[2] 顾刚 CAI Pei;XU Kai;NIU Lei(Department of Medical Imaging Academy,XuzhouMedical University,Xuzhou 221004,Jiangsu Province,China)

机构地区：[1]徐州医科大学医学影像学院,江苏徐州221004 [2]南京鼓楼医院集团宿迁市人民医院影像科,江苏宿迁223800 [3]南京鼓楼医院集团宿迁市人民医院神经外科,江苏宿迁223800

出　　处：《中国CT和MRI杂志》2018年第11期8-10,I0001,共4页Chinese Journal of CT and MRI

基　　金：宿迁市指导性科技计划项目;项目编号:Z2018067

摘　　要：目的探讨动态四维CT血管造影(four-dimensional CT angiography,4DCTA)联合全脑灌注成像(CTperfusion imaging,CTP)对缺血性脑卒中的诊断价值。方法对42例临床怀疑缺血性脑卒中患者进行全脑灌注成像和常规头颅CTA检查,通过灌注原始数据重建获得4DCTA,对图像质量、血管狭窄程度及灌注参数等进行分析。结果 4D-CTA与常规CTA的图像质量评分分别为(2.67±0.48)和(2.81±0.39),差异无统计学意义(P>0.05)。4D-CTA与常规CTA诊断血管狭窄或闭塞结果一致,35例患者存在不同程度的狭窄或闭塞。4D-CTA显示侧支循环较常规CTA多2例,而且重度狭窄及闭塞患者侧支循环显示率明显高于轻、中度狭窄患者。CTP发现34例患者灌注异常,8例灌注正常。CTA责任血管狭窄者CTP阳性率(71.43%)明显高于无责任血管狭窄者(9.52%)。结论 4D-CTA联合CTP不仅可用于动态观察全脑血流状态,还能清晰显示脑血管的异常变化,可以替代常规头颅CTA检查,为临床提供更加丰富的影像学信息。Objective To explore the value of four-dimensional CT angiography combined with whole brain CT perfusion imaging in the diagnosis of ischemic stroke.Methods The whole brain CT perfusion imaging and conventional head CTA examination were performed in 42 patients with ischemic stroke.Meanwhile the whole brain plain images and 4 D-CTA images were also generated from volumetric data acquired in the whole brain CTP.Images quality,vascular stenosis degree and CTP parameters were analyzed.Results The image quality ratings for 4 D-CTA and the conventional CTA are(2.67±0.48)and(2.81±0.39)respectively.4 D-CTA and conventional CTA diagnosis of cerebral artery stenosis were not significantly different(P >0.05),and there was definite consistency.4 D-CTA found that the cerebral artery of 7 cases were normal,35 cases had different degrees of stenosis or occlusion.4 D-CTA showed more collateral circulation than conventional CTA in 2 cases,moreover,the rate of collateral circulation in patients with severe stenosis and occlusion was significantly higher than that in patients with mild or moderate stenosis.CT perfusion imaging was positive in 34 patients and negative in 8 patients.The CTA vasoconstriction patients demonstrated a striking higher CTP positive rate compared with the ones without hemadostenosis.Conclusion 4 D-CTA combined with CTP can not only monitor the cerebral hemodynamics conditions,but can also clearly demonstrate the changes of cerebral artery,which can replace the conventional CTA examination,and provide more comprehensive information for clinical treatment.

关 键 词：血管造影术 缺血性脑卒中 灌注成像 计算机体层X线摄影 

分 类 号：R743.31[医药卫生—神经病学与精神病学]