64排CT全脑灌注成像在急性脑梗死早期诊断价值的初步探讨

Application of 64 multi -slice spiral CT cerebral perfusion imaging in patients with hyperacute stroke

目的探讨64排cT全脑灌注成像（CTP）在急性期脑梗死早期诊断中的应用价值。方法使用Philips公司生产的Brilliance64排螺旋CT机对21例发病6h或12h内的急性期脑梗死患者进行CT平扫及CTP检查，分析比较平扫及灌注成像表现，测量病变区与对侧相应区域的脑灌注参数值。结果21例患者中，C平扫5例显示局部脑沟较对侧变窄、脑实质密度稍微降低等可疑早期脑梗死征象，4例有陈旧腔隙性脑梗死，11例未发现异常征象。CTP检查21例患者均发现脑灌注异常，其中5例患者发现2处异常，4例发现3处异常。CTP表现为脑血流量及脑血容量减低，达峰时间延迟。结论CTP能够早期、快速显示脑缺血的部位及程度，预测缺血半暗带；对急性脑梗死的早期诊断和指导治疗有重要的临床价值。

Objective To evaluate the application of 64 multi -slice spiral CT cerebral perfusion imaging （CTP） in patients with hyperacute stroke. Methods Conventional cerebral plain CT and CTP were performed in 21 patients with hyperacute ischemic stroke within 6 - 12 hours of onset of symptom. All cases were reexamined by cerebral plain CT after 2 to 12 days. Dynamic CTP images were processed with the＂CT Perfusion＂software package on workstation. Quantitative analysis of cerebral perfusion parmneters were performed on CTP im- ages. Results Conventional plain CT of the 21 cases found no abnormality in 11 cases and early infarction signs in 5 cases. However,abnormal perfusion changes were found in all 21cases,including decrease in cerebral blood flow（CBF） and cerebral blood volume（CBV） , delayed time to peal（（TTP）. There were significant differences of CBF, CBV and TTP between infarction side and contralateral side （ P 〈 0.01 ）. Conclusion CTP can early show the ischemic extent and penumbra in patients with hyperacute stroke.