全脑CT灌注成像诊断小体积急性脑梗死及其评估病灶体积与弥散加权成像的相关性  

Whole-brain CT perfusion imaging for diagnosing small-volume acute cerebral infarction and evaluation on lesion volume:Correlation with diffusion weighted imaging

作　　者：赵松 张智琴 刘岩 何业举 季光[3] 刘丹 ZHAO Song;ZHANG Zhiqin;LIU Yan;HE Yeju;JI Guang;LIU Dan(Department of Radiology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Teaching and Research,College of Integrative Medicine,Hebei University of Chinese Medicine,Shijiazhuang 050000,China;Department of Neurology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院医学影像科,河北石家庄050000 [2]河北中医学院中西医结合学院医学影像教研室,河北石家庄050000 [3]河北医科大学第二医院神经内科,河北石家庄050000

出　　处：《中国医学影像技术》2022年第8期1157-1161,共5页Chinese Journal of Medical Imaging Technology

基　　金：河北省重点研发计划(20377789D);河北省医学科学研究课题计划(20210446)。

摘　　要：目的观察全脑CT灌注成像(CTP)对小体积(体积≤8ml)急性脑梗死(ACI)的诊断价值,分析CTP定量参数图评估的ACI灶体积与弥散加权成像(DWI)的相关性。方法回顾性对比分析58例经DWI证实的小体积ACI患者的全脑CTP及DWI资料,统计ACI灶数目,以DWI结果为标准,评价CTP图及脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)及达峰时间(TTP)图诊断ACI灶的敏感度。设置CBV绝对值<2.0 ml/100g及相对MTT>145%,评估是否存在缺血半暗带,并获得核心梗死区;比较ACI灶核心梗死区及缺血半暗带与其对侧镜像区和核心梗死区与缺血半暗带的CBV、CBF、MTT及TTP的差异,观察CTP各参数图与DWI评估ACI灶体积的相关性。结果DWI共于58例ACI检出70个小病灶。CTP检出41例55个小病灶,其中8个为假阳性病灶,CTP检出ACI灶的敏感度为67.14%(47/70),CBV、CBF、MTT及TTP图的诊断敏感度分别为37.14%(26/70)、42.86%(30/70)、62.86%(44/70)及64.29%(45/70)。70个ACI灶中,共38个存在缺血半暗带。较其镜像区及缺血半暗带,核心梗死区的CBV及CBF均减低、MTT均延长(P均<0.01),而TTP差异均无统计学意义(P均>0.05)。相比其镜像区,缺血半暗带CBF减低、MTT及TTP延长(P均<0.01),CBV差异无统计学意义(P=0.23)。CBV、CBF、MTT、TTP图与DWI评估的ACI灶体积均呈线性相关(R2=0.87、0.84、0.74、0.76,P均<0.01)。结论全脑CTP有助于诊断小体积ACI,相关定量参数可评估ACI灶核心梗死区及缺血半暗带;CTP参数图与DWI评估的ACI灶体积具有良好的相关性。Objective To observe the diagnostic value of whole brain CT perfusion(CTP)for small volume(volume≤8 ml)acute cerebral infarction(ACI),and to analyze the correlations of ACI focal volume evaluated with CTP quantitative parameter maps and diffusion weighted imaging(DWI).Methods Data of whole brain CTP and DWI of 58 patients with small volume ACI confirmed by DWI were retrospectively analyzed,and the amount of ACI lesions were counted.The diagnostic sensitivity of CTP and relative quantitative parameter maps,including cerebral blood volume(CBV),cerebral blood flow(CBF),mean transit time(MTT)and time to peak(TTP)for ACI lesions were estimated according to DWI results.CBV absolute value<2.0 ml/100 g and relative MTT>145%were set to evaluate the presence of ischemic penumbra and obtain core infarct areas.CBV,CBF,MTT and TTP of ACI lesions core infarct areas,ischemic penumbra areas and the mirror areas were compared,so as core infarct areas and ischemic penumbra areas.The correlations between CTP parameter maps and DWI for estimating volume of ACI lesions were observed.Results Totally 70 lesions were detected with DWI in 58 patients.CTP detected 55 small lesions in 41 cases,including 8 false positive lesions.The sensitivity of CTP for detecting ACI lesions was 67.14%(47/70),of CBV,CBF,MTT and TTP maps was 37.14%(26/70),42.86%(30/70),62.86%(44/70)and 64.29%(45/70),respectively.Among 70 ACI lesions,ischemic penumbra was observed in 38 lesions.Compared with the mirror areas and ischemic penumbra,in the core infarct areas,CBV and CBF reduced,MTT prolonged(all P<0.01),while TTP were not different(both P>0.05).Compared with the mirror areas,ischemic penumbra had lower CBF,longer MTT and TTP(all P<0.01),and there was no statistical significance of CBV(P=0.23).The volume of ACI lesion estimated with CBV,CBF,MTT and TTP maps linearly correlated with that of DWI(R~2=0.87,0.84,0.74,0.76,all P<0.01).Conclusion Whole-brain CTP was helpful for diagnosing small ACI,and the quantitative parameters could be used to evaluate the core i

关 键 词：脑梗死 弥散磁共振成像 体层摄影术 X线计算机 灌注成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445[医药卫生—临床医学]