CT灌注成像联合CT血管造影诊断超早期缺血性脑血管病的价值

The value of combined application of CT perfusion imaging and CT angiography in the diagnosis of hyperacute ischemic cerebrovascular disease

目的 研究CT灌注成像 (CTPI)联合CT血管造影 (CTA)对超早期缺血性脑血管病 (ICVD)的诊断价值。方法 对 4 6例ICVD患者 ,在发病 6h内进行头颅CT平扫、CTPI及CTA检查。结果 ⑴CT平扫 :显示低密度灶 5例 ,未见异常 4 1例 ;⑵CTPI:脑血流灌注正常 16例 ,异常 30例 ;⑶CTA :2 7例患者大脑中动脉(MCA)、大脑前动脉 (ACA)不同程度狭窄 ,2例MCA明显变细 ,17例CTA图像正常 ;⑷ 2 5例大、中体积脑梗死患者CTPI图像均显示相应灌注缺损区 ,CTA均显示血管狭窄或闭塞。 9例小体积脑梗死患者中 ,CTPI显示灌注缺损区 5例 ,正常 4例 ;CTA显示血管狭窄 2例 ,正常 7例。 12例短暂性脑缺血发作 (TIA)患者CTPI均正常 ,2例CTA显示MCA明显变细 ,远侧血管网增多 ;其余 10例正常。结论 CTPI联合CTA能够超早期诊断ICVD ,并可鉴别TIA及不同梗死体积的脑梗死。

Objective To evaluate the value of combined application of computed tomography perfusion imaging(CTPI)and CT angiography(CTA) in the diagnosis of hyperacute ischemic cerebrovascular disease.Methods 46 patients with hyperacute ischemic cerebrovascular disease(onset within 6 hours) were examined by conventional CT , CTPI and CTA.Results Conventional CT scan showed low density signal in 5 of 46 patients. CTPI revealed normal perfusion in 16 patients and hypoperfusion in 30 patients. 27 patients existed stenosis or occlusion of middle cerebral arteries(MCA) and anterior cerebral arteries(ACA) by CTA. CTA also showed obvious slight MCA in 2 cases and normal image in 17 cases. 25 cases with large or moderate cerebral infarction volume were confirmed by CTPI as having ischemic hypoperfusion lesions and stenosis or occlusion of arteries by CTA. In 9 cases with small cerebral infarction volume, CTPI revealed perfusion defect in 5 patients and CTA displayed stenosed arteries in 2 patients. CTPI of 12 patients with TIA were normal. But CTA showed remarkable slight MCA and more blood vessel network in its distal segment in 2 of 12 patients.Conclusion combined application of CTPI and CTA can detect hyperacute ischemic lesion at far more early stage. They are helpful in differentiation TIA from infarcts with different volumes.