CT与MRI对急性脑梗死患者脑血管及灌注的诊断效能对照研究  

Comparative study on the diagnostic efficacy of CT and MRI in cerebral vessels and perfusion of acute cerebral infarction

作　　者：胡俊秋 赵江[1] 刘科位 王力[2] HU Junqiu;ZHAO Jiang;LIU Kewei;WANG Li(Department of Neurology,Rongxian People's Hospital,Zigong Sichuan 643100,China)

机构地区：[1]荣县人民医院神经内科,四川自贡643100 [2]自贡市第三人民医院神经内科,四川自贡643020

出　　处：《中国急救复苏与灾害医学杂志》2024年第6期782-785,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：重庆市科卫联合医学科研项目重点项目(编号:2023ZDXM025)。

摘　　要：目的探究计算机断层扫描(CT)、磁共振成像(MRI)对急性脑梗死患者脑血管及脑灌注的诊断效能差异。方法采用前瞻性研究方式,选取2020年2月—2022年4月荣县人民医院收入的76例急性脑梗死患者为研究对象。所有患者均接受了CT血管成像(CTA)、CT灌注(CTP)、MRI检查[含高分辨Cube T1WI、多延迟伪连续动脉自旋标记(pCASL)]以及数字减影血管造影(DSA)检查。以DSA检查结果为金标准,分析MRI相关检查、CTA对急性脑梗死患者脑血管狭窄程度诊断的差异性,以Kappa值表达CTA、MRI与DSA诊断结果的一致性。由多延迟pCASL检查得到脑血流量(CBF),由CTP检查得到CBF、平均通过时间(MTT),于体素水平基础上比较在灰质、白质、全脑区域上多延迟pCASL、CTP灌注参数间Pearson相关系数差异。结果以DSA结果为金标准,76例急性脑梗死患者在通过MRI、CT、DSA检查后有69例相同患者被发现存在不同程度狭窄。与DSA结果诊断结果相比,Cube T1WI诊断中4例患者狭窄程度偏高,1例患者偏低;CTA诊断中5例患者狭窄程度偏高,3例患者偏低。三种诊断方式结果比较,Kappa值均处于0.800~1.000范围内,具有高度一致性(P<0.05)。PLD为1500 ms、1800 ms、2500 ms时pCASL的CBF值分别为(25.63±12.17)mL/(100 g·min)、(39.78±17.53)mL/(100 g·min)、(32.64±15.12)mL/(100 g·min)。pCASL所得CBF值与CTP所得CBF值、MTT值在PLD为1500 ms、1800 ms、2500 ms时均呈显著正相关(P<0.05)。结论在急性脑梗死患者脑血管、脑灌注评估中CT、MRI均有较好诊断效能,但MRI检查中的Cube T1WI与DSA脑血管诊断一致性更高,多延迟pCASL灌注安全性更好。Objective To explore the difference of diagnostic efficacy between computed tomography(CT)and magnetic resonance imaging(MRI)in cerebral blood vessels and cerebral perfusion in patients with acute cerebral infarction.Methods 76 patients with acute cerebral infarction from February 2020 to April 2022 in our hospital were selected as the study subjects by a prospective study.All patients underwent CT angiography(CTA),CT perfusion(CTP),MRI(including high-resolution cube T1WI,multi delayed pseudo continuous arterial spin labeling(pCASL)]and digital subtraction angiography(DSA).Taking the results of DSA as the gold standard,the difference between MRI related examinations and CTA in the diagnosis of cerebral vascular stenosis in patients with acute cerebral infarction were analyzed,and the consistency of CTA,MRI and DSA diagnostic results by Kappa value were expressed.The relevant perfusion parameters cerebral blood flow(CBF)were obtained from the multi delayed pCASL examination,and the CBF and mean transit time(MTT)were obtained from the CTP examination.The Pearson correlation coefficient differences between the multi delayed pCASL and CTP perfusion parameters in gray matter,white matter and whole brain regions were compared on the basis of voxel level.Results Taking DSA results as the gold standard,69 of 76 patients with acute cerebral infarction were found to have stenosis of different degrees after MRI,CT and DSA.Compared with the results of DSA,the stenosis degree of 4 patients was high in cube T1WI,1 patient was low,5 patients were high in CTA,and 3 patients were low.Compared with the results of the three diagnostic methods,Kappa values were all in the range of 0.800-1.000,with high consistency(P<0.05).The CBF values of pCASL were(25.63±12.17)mL/(100 g·min),(39.78±17.53)mL/(100 g·min),(32.64±15.12)mL/(100g·min)when PLD was 1500 ms,1800 ms and 2500 ms,respectively.The CBF value obtained by pCASL was significantly positively correlated with the CBF value obtained by CTP and MTT treatment at the PLD of 1500 ms

关 键 词：计算机断层扫描 磁共振成像 急性脑梗死 脑血管 灌注 诊断效能 

分 类 号：R445.3[医药卫生—影像医学与核医学] R743[医药卫生—诊断学]