全脑CT灌注成像诊断急性脑梗死的价值  

The value of whole brain CT Perfusion imaging in diagnosis of acute cerebral infarction

作　　者：兰勇军 汪文涛 刘新立 吕新胜[1] LAN Yongjun;WANG Wentao;LIU Xinli;LV Xinsheng(Medical Imaging Center,Karamay Central Hospital,Xinjiang,Karamay 834000,China)

机构地区：[1]新疆维吾尔自治区克拉玛依市中心医院医学影像中心,新疆克拉玛依834000

出　　处：《中国医药科学》2022年第1期149-152,166,共5页China Medicine And Pharmacy

基　　金：新疆维吾尔自治区克拉玛依市中心医院第一批青年科研基金(QK2018-4)。

摘　　要：目的探讨全脑CT灌注(CTP)诊断急性脑梗死及评估责任动脉的应用价值。方法纳入克拉玛依市中心医院2017年9月至2019年9月收治的急性脑梗死患者26例行回顾性分析,所有患者在24 h内均行CTP、MRI-T_(2)WI及MRI-DWI检查。重建CTP及CTA图像,评价梗死灶的CT灌注参数、颅内责任动脉病变及侧支循环情况。对照分析CTP与MRI+DWI图像中梗死灶的位置、大小以及梗死核心的一致性。结果26例患者中CTP及MRI均发现29处梗死灶,两者的符合率为100%,与对侧对照,梗死中心区CBF及CBV下降,梗死周边区CBF下降、TTP延长,两者间的差异有统计学意义(P<0.05)。对比MRI结果,梗死核心范围的差异无统计学意义(P>0.05)。29处梗死灶者均存在责任动脉的病变,轻度狭窄2例,中度狭窄7例,重度狭窄12例,闭塞8例。19个病灶存在缺血半暗带,14例患者存在侧支循环。结论320排MSCT全脑CTP适应证范围广,可对脑缺血病灶准确诊断,同时能有效评价病灶灌注状态、责任供血动脉及侧支循环状况。Objective To investigate the application of whole brain Computed tomography perfusion(CTP)for the diagnosis of acute cerebral infarction and evaluation of the responsible artery.Methods A total of twenty six patients with acute cerebral infarction admitted to Karamay Central Hospital between September 2017 and September 2019 were retrospectively included.All patients underwent CTP,MRI-T_(2)WI and MRI-DWI within 24 h.CTP and CTA images were reconstructed to evaluate CT perfusion parameters of the infarct,intracranial responsible artery lesions and collateral circulation.The locations and sizes of infarct foci and the concordance of infarct cores between CTP and MRI+DWI images were analyzed separately.Results In 26 patients,29 infarcts were found by both CTP and MRI,the concordance rate was 100%for both.Compared with the contralateral control,the decrease of CBF and CBV in the central area and the decrease of CBF and TTP in the peripheral area were statistically significant(P<0.05).In contrast to the MRI findings,the differences in infarct core extent were not statistically significant(P>0.05).Lesions of the responsible artery were present in all 29 infarcted lesions,with mild stenosis in 2,moderate stenosis in 7,severe stenosis in 12,occlusion in 8,ischemic penumbra in 19,and collateral circulation in 14 patients.Conclusion The whole brain CTP with 320 row MSCT has a wide range of indications,which can accurately diagnose cerebral ischemic lesions,and at the same time can effectively evaluate the evaluation of lesion perfusion status,responsible feeding artery,and collateral circulation status.

关 键 词：急性脑梗死 CT灌注 CT血管成像 体层摄影术 

分 类 号：R651.12[医药卫生—外科学]