探讨CT灌注扫描对急性缺血性脑血管病的诊断价值  

Diagnostic Value of CT Perfusion Scan in Acute Ischemic Cerebrovascular Disease

作　　者：黄鸣宇[1] 彭伟清 韦彩琴 陈其峰 苏桂红 HUANG Ming-yu;PENG Wei-qing;WEI Cai-qin(Department of Medical Imaging,Zhongshan Hospital of Traditional Chinese Medicine,Zhongshan,Guangdong,528400,China)

机构地区：[1]中山市中医院医学影像科,广东中山528400

出　　处：《黑龙江医学》2022年第17期2084-2086,2090,共4页Heilongjiang Medical Journal

摘　　要：目的:探讨CT灌注扫描(CTP)对急性缺血性脑血管病(ICVD)的诊断价值。方法:采取回顾性研究,将2018年8月—2020年7月中山市中医院收治的106例ICVD患者临床资料纳入研究,根据数字减影血管造影诊断结果将其分为急性脑梗死(ACI)组(n=84)、短暂性脑缺血发作(TIA)组(n=22)。所有患者均接受CTP检查,比较两组患者CTP参数[局部脑血流流量(CBF)、脑血流容量(CBV)、对比剂平均通过时间(MTT)、对比剂峰值时间(TTP)],并绘制ROC曲线并计算曲线下面积(AUC)值,分析CBF、CBV、MTT、TTP在ACI、TIA鉴别诊断中的价值。结果:ACI组CBF为(20.58±5.06)m L·min^(-1)·100g^(-1)、CBV为(2.48±0.85)mL·100g^(-1)低于TIA组的健侧(54.92±5.52)mL·min^(-1)·100g^(-1)、(5.51±1.30)mL·100g^(-1)及患侧(54.23±3.34)mL·min^(-1)·100g^(-1)、(5.02±1.08)mL·100g^(-1),MTT为(6.04±1.12)s、TTP为(16.86±4.42)s,长于TIA组的健侧(3.50±0.76)s、(8.72±1.45)s,患侧(5.46±1.34)s、(11.46±2.88)s,差异有统计学意义(F=26.354、22.158、9.684、30.254,P<0.05)。绘制接受者操作特征曲线(ROC曲线),CBF、CBV、MTT、TTP诊断ACI的AUC分别为0.772、0.916、0.738、0.893,均有一定诊断价值,CBF、CBV、MTT、TTP诊断敏感度分别为0.722、0.889、0.722、0.833,特异度分别为0.544、0.750、0.603、0.794,且以CBV、TTP诊断效能较高。结论:通过观察CBF、CBV、MTT、TTP等CTP参数可为早期鉴别ACI、TIA提供可靠依据,且CBV、TTP鉴别诊断ACI、TIA的效能较高。Objective:To investigate the diagnostic value of CT perfusion scan(CTP)in acute ischemic cerebrovascular disease(ICVD).Methods:A retrospective study was conducted,and the clinical data of 106 ICVD patients admitted to the hospital from August 2018 to July 2020 were included in the study,and they were divided into the acute cerebral infarction(ACI)group(n=84and transient ischemic attack(TIA)group(n=22)according to the diagnosis results of digital subtraction angiography.All patients underwent CTP examination.The CTP parameters(regional cerebral blood flow[CBF],cerebral blood flow volume[CBV],contrast medium transit time[MTT],contrast medium peak time[TTP])were compared between the two groups.The ROC curve was drawn and the area under the curve(AUC)value was calculated to analyze the value of CBF,CBV,MTT and TTP in the differential diagnosis of ACI and TIA.Results:The CBF of the ACI group was(20.58±5.06)m L·min^(-1)·100g^(-1),and the CBV was(2.48±0.85)m L·100g^(-1),which were lower than(54.92±5.52)mL·min^(-1)·100g^(-1),(5.51±1.30)m L·100g^(-1)of the healthy side of the TIA group and(54.23±3.34)mL·min^(-1)·100g^(-1),(5.02±1.08)mL·100g^(-1)on the affected side.MTT was(6.04±1.12)s,TTP was(16.86±4.42)s,longer than(3.50±0.76)s,(8.72±1.45)s on the healthy side and(5.46±1.34)s,(11.46±2.88)s on the affected side in the TIA group and the differences were statistically significant(F=26.354,22.158,9.684,30.254,P<0.05).The ROC curve results showed that the AUCs of CBF,CBV,MTT,and TTP in the diagnosis of ACI were 0.772,0.916,0.738,and 0.893,respectively,all of which had certain diagnostic value.The diagnostic sensitivity of CBF,CBV,MTT and TTP was 0.722,0.889,0.722,0.833,and the specificity was 0.544,0.750,0.603,0.794,and the diagnostic efficiency of CBV and TTP was higher.Conclusion:Observing CTP parameters such as CBF,CBV,MTT,TTP can provide a reliable basis for early identification of ACI and TIA,and CBV and TTP have higher efficacy in the differential diagnosis of ACI and TIA.

关 键 词：急性缺血性脑血管病 急性脑梗死 短暂性脑缺血发作 CT灌注扫描 诊断效能 

分 类 号：R743[医药卫生—神经病学与精神病学]