颈部血管彩超及颈部CTA联合CTP对急性脑梗死合并脑血管狭窄的诊断价值  

Diagnostic value of cervical vascular color Doppler ultrasonography and CT angiography combined with CT cerebral perfusion imaging in acute cerebral infarction complicated with cerebral vascular stenosis

作　　者：陈晓华[1] 潘延平[1] 高咏梅[1] 刘小丽[1] CHEN Xiao-hua;PAN Yan-ping;GAO Yong-mei;LIU Xiao-li(Department of Neurology,Hancheng People's Hospital,Weinan 715400,Shaanxi,CHINA)

机构地区：[1]韩城市人民医院神经内科,陕西渭南715400

出　　处：《海南医学》2020年第10期1279-1282,共4页Hainan Medical Journal

摘　　要：目的探究颈部血管彩超(CVUS)及颈部CT血管造影术(CTA)联合CT脑灌注成像(CTP)对急性脑梗死合并脑血管狭窄或闭塞的诊断价值。方法选取2018年1月至2019年4月在韩城市人民医院神经内科治疗的急性脑梗死患者54例作为研究对象,采用数字减影血管造影(DSA)、CVUS、CTA、CTP检查(DSA为检查金标准),重建获取图像,比较病侧区、健侧对照区CTP参数脑灌注值、强化峰值(PE)、达峰时间(TTP)、脑血容量(CBV),并对比分析不同检查方法对脑血管狭窄或闭塞的诊断价值。结果 CTP检查结果显示,病侧区与健侧对照区的脑灌注值[(20.42±6.30) Hu vs (67.58±25.25) Hu]、PE [(4.38±0.53) Hu vs (7.81±0.50) Hu]、CBV [(2.20±0.34) mL/100 g vs (4.61±1.53) mL/100 g]比较,病侧区明显低于健侧对照区,TTP为(13.43±1.28) s,明显多于健侧对照区的(9.95±1.30) s,差异均有统计学意义(P<0.05);54例急性脑梗死患者应用DSA检查,均发现病灶同侧症状性脑动脉狭窄或闭塞,检出率为100%;应用CVUS检查,发现病灶同侧脑血管狭窄或闭塞者为42例,检出率为77.78%,CTA检查发现病灶同侧脑血管狭窄或闭塞41例,检出率为75.93%,CVUS和CTA的检出率明显低于DSA检出率,差异均有统计学意义(P<0.05);而CVUS+CTP检出者51例,检出率为94.44%,CTA+CTP检出者52例,检出率为96.30%,以上两者联合检查的检出率与DSA的检出率比较差异均无统计学意义(P>0.05)。结论 "CVUS+CT"与"CTA+CTP"检查均能够有效判断出急性脑梗死缺血范围,提高急性脑梗死合并症状性脑血管狭窄或闭塞的检出率,且与DSA相比差异不明显,值得推广使用。Objective To explore the diagnostic value of cervical vascular color Doppler ultrasonography(CVUS) and cervical CT angiography(CTA) combined with CT cerebral perfusion(CTP) in acute cerebral infarction with cerebral vascular stenosis. Methods Fifty-four patients with acute cerebral infarction complicated with cerebrovascular stenosis who were treated in Hancheng People’s Hospital from January 2018 to April 2019 were selected as the research objects. Digital subtraction angiography(DSA), CVUS, CTA, and CTP were used to examine and reconstruct the images(with DSA as the gold standard). The cerebral perfusion values of CTP parameters, enhancement peak(PE), time to peak(TTP), cerebral blood volume(CBV) in the disease side and the healthy side were compared. The diagnostic value of different examination methods for cerebral vascular stenosis or occlusion was compared and analyzed. Results The results of CTP examination showed that the cerebral perfusion value, PE, CBV of the disease side were(20.42±6.30) Hu,(4.38±0.53) Hu,(2.20±0.34) m L/100 g, significantly lower than(67.58±25.25) Hu,(7.81±0.50) Hu,(4.61±1.53) mL/100 g inthe healthy side, and TTP was(13.43±1.28) s, significantly higher than(9.95±1.30) s in the healthy side, with statistically significant difference(P<0.05). For the detection rate of CVUS(77.78%, 42/54), CTA(75.93%, 41/54) for cerebrovascular stenosis was lower than DSA detection rate(100.00%, 54/54), and the difference was statistically significant(P<0.05). The detection rate of CVUS+CTP for cerebrovascular stenosis was 94.44%(51/54), and that of CTA+CTP was 96.30%(52/54), which showed no significant difference as compared with the detection rate of DSA(P>0.05).Conclusion "CVUS+CT" or "CTA+CTP" detection can effectively determine the ischemic range of acute cerebral infarction, improve the detection rate of acute cerebral infarction with symptomatic cerebrovascular stenosis or occlusion,with no significant difference with DSA, which can provide more theoretical basis for clinical diagnosis

关 键 词：颈部血管彩超 CT血管造影术 CT脑灌注成像 脑梗死 脑血管狭窄 诊断价值 

分 类 号：R743.33[医药卫生—神经病学与精神病学]