多模式CT对急性前循环缺血性脑卒中患者缺血半暗带、梗死核心变化及预后的评估  

Evaluation of ischemic penumbra,infarct core changes and prognosis in patients with acute anterior circulation ischemic stroke by multimodal CT

作　　者：霍敏中[1] 冯锦昉[2] 方挺松[1] 梁振华[1] HUO Min-zhong;FENG Jin-fang;FANG Ting-song(Department of Imaging,Foshan Hospital of Traditional Chinese Medicine,Foshan Guangdong 528000,China;Department of Emergency,Foshan Hospital of Traditional Chinese Medicine,Foshan Guangdong 528000,China)

机构地区：[1]佛山市中医院影像科,广东佛山528000 [2]佛山市中医院急诊科,广东佛山528000

出　　处：《临床和实验医学杂志》2024年第8期863-867,共5页Journal of Clinical and Experimental Medicine

基　　金：广东省中医药局科研项目(编号:20212219);佛山市自筹经费类科技创新项目(编号:2220001004950)。

摘　　要：目的 探讨多模式CT对急性前循环缺血性脑卒中患者缺血半暗带、梗死核心变化及预后的评估。方法 回顾性选取2021年1月至2023年6月来佛山市中医院诊治的疑似急性前循环缺血性脑卒中患者100例,治疗前后分别行多模式CT检查。分析头颅CT平扫(NCCT)、CT灌注成像(CTP)、CT血管成像(CTA)结果。比较急性前循环缺血性脑卒中患者缺血半暗带区、梗死核心区患侧与健侧的脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)、达峰时间(TTP)值;比较治疗前后急性前循环缺血性脑卒中患者缺血半暗带的灌注参数[相对脑血容量(rCBV)、相对脑血流量(rCBF)、相对平均通过时间(rMTT)和相对达峰时间(rTTP)];比较治疗前后急性前循环缺血性脑卒中患者梗死核心的灌注参数(rCBF、rCBV、rTTP、rMTT);分析脑组织异常灌注与血管狭窄的相关性。43例急性前循环缺血性脑卒中患者根据发病4.5~9.0 h内经溶栓治疗结果,比较预后良好(改良Rankin评分≤2分,n=28)与预后不良(改良Rankin评分>2分,n=15)缺血半暗带的rCBV、rCBF、rMTT、rTTP值。结果 100例疑似患者经NCCT检查发现,59例患者可见早期的低密度病灶,其余41例患者未见明显异常,NCCT阳性率为59.00%。CTP检查结果发现,100例患者中9例经过CTP检查灌注正常,其余91例患者脑灌注均有异常现象,与临床症状相符,CTP检查发现阳性率为91.00%。CTA检查结果发现,存在责任血管狭窄或闭塞者88例,无存在责任血管狭窄或闭塞者12例。多模式CT结果:急性前循环缺血性脑卒中缺血半暗带区健侧、患侧CBV比较,差异无统计学意义(P>0.05),患侧的CBF明显较健侧低,患侧的MTT、TTP明显较健侧高,差异均有统计学意义(P<0.05)。梗死核心区患侧的CBV、CBF明显较健侧低,MTT、TTP明显较健侧高,差异均有统计学意义(P<0.05)。与梗死核心区相比,缺血半暗带的rCBV、rCBF明显较高,rMTT、rTTP值明显较低,差异均�Objective To investigate the assessment of ischemic semidarkness zone,infarct core changes,and prognosis in patients with acute anterior circulation ischemic stroke by multimodal CT.Methods This study was a retrospective analysis,100 patients with suspected acute anterior circulation ischemic stroke who came to Foshan Hospital of Traditional Chinese Medicine from January 2021 to June 2023 were selected and underwent multi-modality CT examination before and after treatment.The results of non-contrast CT(NCCT),CT perfusion imaging(CTP),and CT angiography(CTA) were analyzed,and the values of cerebral blood volume(CBV),cerebral blood flow(CBF),mean time to transit(MTT),and time to peak(TTP) in the ischemic semi-dark band region,infarcted core region of patients with acute anterior circulation ischemic stroke with those of the healthy side before and after treatment were compared,and the values of ischemia and ischemia in patients with acute anterior circulation ischemic stroke with those of the healthy side before and after treatment were compared.Perfusion parameters [relative cerebral blood volume(rCBV),relative cerebral blood flow(rCBF),relative mean transit time(rMTT),and relative time to peak(rTTP)] in ischemic hemidiaphragm in patients with ischemic stroke,comparing perfusion parameters(rCBF,rCBV,rTTP,rMTT) in the infarct core of patients with ischemic stroke in the acute anterior circulation before and after treatment.The correlation between abnormal perfusion of brain tissue and vascular stenosis was analyzed.Forty-three patients with acute anterior circulation ischemic stroke were diagnosed with good prognosis(modified Rankin score≤2,n=28) and poor prognosis(modified Rankin score>2,n=15) based on thrombolytic therapy within 4.5-9.0 hours of onset.The rCBV,rCBF,rMTT,and rTTP values of ischemic penumbra with good and poor prognosis were compared.Results NCCT examination of 100 suspected patients found that 59 patients could see early hypodense lesions,and the remaining 41 patients did not see obvious abnorma

关 键 词：急性前循环缺血性脑卒中 多模式CT 梗死核心 缺血半暗带 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]