低剂量双源CTP评估急性缺血性脑卒中患者脑组织灌注缺损的价值及对血管内再通治疗的指导意义  

The Value of Low-dose Dual-source CTP in Assessing Perfusion Deficits in Brain Tissue of Patients with Acute Ischemic Stroke and Its Guidance for Endovascular Recanalization Therapy

作　　者：周戈 李培华 杨才能 尹伊君[1] ZHOU Ge;LI Pei-hua;YANG Cai-neng;YIN Yi-jun(Department of Radiology Diagnostic,909 Hospital(Dong Nan Hospital of Xiamen University),Zhangzhou 363000,Fujian Province,China;Department of Imaging,Zhangzhou Second Hospital,Zhangzhou 363000,Fujian Province,China)

机构地区：[1]第九〇九医院(厦门大学附属东南医院)放射诊断科,福建漳州363000 [2]漳州市第二医院影像科,福建漳州363000

出　　处：《中国CT和MRI杂志》2024年第1期15-17,共3页Chinese Journal of CT and MRI

基　　金：2017年度青年苗圃基金资助项目(17Y026)。

摘　　要：目的探究低剂量双源CT灌注成像(CTP)评估急性缺血性脑卒中(AIS)脑组织灌注缺损及指导血管内再通治疗的价值。方法选取2020年8月~2022年8月我院106例AIS患者,随机分为低剂量组(n=53)和常规剂量组(n=53),分别于发病4.5 h内行低剂量、常规剂量双源CTP检查。比较低剂量组和常规剂量组CTP参数[脑血流量(CBF)、脑血容量(CBV)、达峰时间(TTP)、平均通过时间(MTT)]、图像质量、辐射剂量、脑组织灌注异常率及脑组织灌注缺损面积,分析治疗前低剂量CTP参数与美国国立卫生研究院卒中量表(NIHSS)评分的相关性。所有患者均行血管内再通治疗,比较低剂量组不同疗效患者治疗前低剂量CTP参数,分析治疗前低剂量CTP参数预测疗效的价值。结果低剂量组和常规剂量组CTP参数CBF、CBV、TTP、MTT、图像质量评分及脑组织灌注异常率、脑组织灌注缺损面积比较,差异无统计学意义(P>0.05);低剂量组辐射剂量低于常规剂量组(P<0.05);低剂量组CTP参数CBF、CBV与NIHSS评分呈负相关,TTP、MTT与NIHSS评分呈正相关(P<0.05);低剂量组疗效不良患者治疗前CBF、CBV低于疗效良好患者,TTP、MTT高于疗效良好患者(P<0.05);治疗前低剂量CTP参数CBF、CBV、TTP、MTT预测AIS患者血管内再通治疗疗效为不良的曲线下面积(AUC)分别为0.717、0.820、0.702、0.817。结论低剂量双源CTP能满足评估AIS患者脑组织灌注缺损的临床要求,且能辅助临床预测血管内再通治疗疗效,有助于指导临床选择血管内再通治疗方案。Objective To investigate the value of low-dose dual-source CT perfusion imaging(CTP)to assess brain tissue perfusion deficits in acute ischemic stroke(AIS)and to guide endovascular recanalization therapy.Methods From August 2020 to August 2022,106 patients with AIS in our hospital were randomly divided into low dose group(n=53)and conventional dose group(n=53).Low dose and conventional dose dual-source CTP were performed within 4.5 hours after the onset of the disease.Compare the CTP parameters[cerebral blood flow(CBF),cerebral blood volume(CBV),time to peak(TTP),mean transit time(MTT)],image quality,radiation dose,abnormal rate of brain tissue perfusion and area of brain tissue perfusion defect between the low-dose group and the conventional dose group,and analyze the correlation between the low-dose CTP parameters and the NIHSS score before treatment.All patients were treated with intravascular recanalization.The low-dose CTP parameters of patients with different therapeutic effects in the low-dose group were compared before treatment,and the value of low-dose CTP parameters in predicting the therapeutic effect was analyzed.Results The CTP parameters CBF,CBV,TTP,MTT,image quality score,abnormal rate of brain tissue perfusion and the area of brain tissue perfusion defect were not significantly different between the low-dose group and the conventional dose group(P>0.05);The radiation dose of low dose group was lower than that of conventional dose group P;The CTP parameters CBF and CBV in low dose group were negatively correlated with NIHSS score,while TTP and MTT were positively correlated with NIHSS score(P<0.05);Before treatment,CBF and CBV of patients with poor efficacy in low-dose group were lower than those with good efficacy,while TTP and MTT were higher than those with good efficacy(P<0.05);pre-treatment low-dose CTP parameters CBF,CBV,TTP,and MTT predicted the efficacy of endovascular recanalization therapy in AIS patients as poor The area under the curve(AUC)was 0.717,0.820,0.702,and 0.817,respectively.C

关 键 词：急性缺血性脑卒中 低剂量双源CT灌注成像 脑组织灌注缺损 血管内再通治疗 

分 类 号：R742.3[医药卫生—神经病学与精神病学]