全脑灌注CTP联合头颈CTA诊断早期AIS的价值观察  

Value of Whole Brain CTP Combined with Head and Neck CTA in the Diagnosis of Early AIS

作　　者：段淼 陈大有 郭泽春 黄春兰 张凯 肖丹丹 陈佳林 张力 DUAN Miao;CHEN Da-you;GUO Ze-chun;HUANG Chun-lan;ZHANG Kai;XIAO Dan-dan;CHEN Jia-lin;ZHANG Li(Department of Radiology,Shunyi Hospital,Beijing Hospital of Traditional Chinese Medicine,Beijing 101300,China;Department of Cerebrology,Shunyi Hospital,Beijing Hospital of Traditional Chinese Medicine,Beijing 101300,China;Physical Examination Center of North Guangdong People's Hospital Affiliated to Shantou University School of Medicine,Shantou 512026,Guangdong Province,China)

机构地区：[1]北京中医医院顺义医院放射科,北京101300 [2]北京中医医院顺义医院脑病科,北京101300 [3]汕头大学医学院附属粤北人民医院体检中心,广东汕头512026

出　　处：《中国CT和MRI杂志》2024年第1期4-6,共3页Chinese Journal of CT and MRI

基　　金：韶关市卫生健康科研项目(Y21301)。

摘　　要：目的探究全脑CT灌注成像(CTP)联合头颈CT血管成像(CTA)对早期急性缺血性脑卒中(AIS)的诊断价值。方法选取我院63例疑似AIS患者为研究对象,所有患者入院后均行全脑灌注CTP检查、头颈CTA检查及数字减影血管造影术(DSA)检查。以DSA检查为“金标准”,分析CTP、CTA单独及联合诊断早期AIS的价值、梗死区和健侧脑组织的CTP参数大小[脑血流量图(CBF)、脑血容量图(CBV)、平均通过时间(MTT)及达峰时间(TTP)]、CTA对头颈动脉狭窄程度的检出情况,采用Spearman相关性分析CTP参数与头颈动脉狭窄程度的相关性。结果CTP诊断AIS阳性47例,阴性16例,诊断敏感度为91.84%,特异度85.71%,阳性预测值95.74%,阴性预测值75.00%,准确率为90.48%,Kappa值为0.738;CTA诊断AIS阳性46例,阴性17例,诊断敏感度为87.76%,特异度78.57%,阳性预测值93.48%,阴性预测值64.71%,准确率为85.71%,Kappa值为0.616;CTP联合CTA诊断AIS阳性48例,阴性15例,诊断敏感度为95.92%,特异度92.86%,阳性预测值97.92%,阴性预测值86.67%,准确率为95.24%,Kappa值为0.866,联合诊断价值更高。灌注异常区CBF、CBV值显著低于对侧正常区(P<0.05),MTT、TTP值显著高于对侧正常区(P<0.05);63例患者DSA共检出狭窄血管107处,其中轻度狭窄22处,中度狭窄46处,重度狭窄30处,闭塞9处,CTA检测轻度狭窄21处,中度狭窄47处,重度狭窄31处,闭塞8处,准确率分别为95.23%、89.36%、87.10%、100%,总准确率为90.65%;CTA检查动脉狭窄程度与CBF、CBV呈显著负相关(P<0.05),与MTT、TTP呈显著正相关(P<0.05)。结论全脑灌注CTP可有效评估脑组织血流动力学变化和缺血严重程度,头颈CTA则可准确检测脑动脉血管狭窄部位和程度,两者联合诊断早期AIS价值较高,为临床疾病诊断和治疗方案选择提供参考。Objective To explore the diagnostic value of whole brain CT perfusion imaging(CTP)combined with head and neck CT angiography(CTA)on early acute ischemic stroke(AIS).Methods 63 patients with suspected AIS in the hospital were selected as the study subjects.All patients underwent whole brain CTP examination,head and neck CTA examination and digital subtraction angiography(DSA)examination after admission.Using DSA examination as the gold standard,the value of DTP and CTA alone and in combination in diagnosing early AIS,CTP parameters[cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT),time to peak(TTP)]of infarct area and healthy brain tissue and the detection of head and carotid artery stenosis degree by CTA were analyzed.Spearman correlation analysis was used to analyze the correlation between CTP parameters and head and neck artery stenosis degree.Results CTP diagnosed 47 cases of positive AIS and 16 negative cases,and the diagnostic sensitivity,specificity,positive predictive value,negative predictive value,accuracy rate and Kappa value were 91.84%,85.71%,95.74%,75.00%,90.48%and 0.738.CTA diagnosis of AIS was positive in 46 cases and negative in 17 cases,and the sensitivity,specificity,positive predictive value,negative predictive value,accuracy rate and Kappa value of CTA were 87.76%,78.57%,93.48%,64.71%,85.71%and 0.616.CTP combined with CTA in the diagnosis of AIS showed that there were 48 positive cases and 15 negative cases,with diagnostic sensitivity of 95.92%,specificity of 92.86%,positive predictive value of 97.92%,negative predictive value of 86.67%,accuracy rate of 95.24%and Kappa value of 0.866.The combined diagnosis had higher value.The CBF and CBV in the abnormal perfusion area were significantly lower than those in the contralateral normal area(P<0.05)while the MTT and TTP were significantly longer than those in the contralateral normal area(P<0.05).A total of 107 sites of stenosis vessels were detected by DSA in 63 patients,including 22 sites of mild stenosis,46 sites of mode

关 键 词：CT灌注成像 CT血管成像 急性缺血性脑卒中 动脉狭窄 诊断价值 

分 类 号：R543.5[医药卫生—心血管疾病]