缺血性脑卒中急性期CT灌注成像与临床的相关性

The relationship between computed tomography perfusion imaging and clinical findings in acute ischemic cerebral stroke

目的探讨CT灌注成像(CTP)对缺血性卒中急性期的诊断价值,并观察影像学检查与临床的相关性。方法31例急性半球梗死者在发病24h内行头颅CT和CTP检查,同时进行美国国立卫生院神经功能缺损评分(NIHSS),其中18例在发病后12～72h内行头颅MRI+弥散成像(DWI),25例于发病后14～80d复查CT,同时进行NIHSS评分。结果24h内CT和CTP诊断敏感度分别为25.8%和90.3%,6h内CTP诊断敏感度88.2%。DWI上高信号的范围与局部脑血容量(CBV)的缺损程度间有相关关系;最初NIHSS评分与灌注缺损面积及灌注缺损程度无相关关系,而最终NIHSS评分与DWI异常面积和梗死面积有相关关系。结论CTP对超早期半球缺血有诊断价值,能发现缺血半暗带,可成为急性半球缺血的常规检查。最终的神经功能缺损与DWI异常面积和最后梗死面积相关。

Objective To investigate the diagnostic value of computed tomography perfusion imaging （CTP） in acute cerebral ischemic stroke and to assess the relationship between CTP and clinical data. Methods Conventional computed tomography （CT） scan and CTP of the brain were performed and National Institutes of Health Stroke Scale score （NIHSS） was assessed within 24 hours of symptom onset in 31 patients diagnosed as having hemisphere infarction, diffusion-weighted magnetic resonance （DWI） was also performed in 18 patients within 12-72 hours, CT scan was reexamined within 14--80 days in 25patients, and NIHSS was assessed again at the same time. Results In 31 cases of hemisphere infarction the diagnostic sensitivity of CT and CTP was 25.8% and 90. 3% respectively within 24 hours of symptom, and that of CTP was 88. 2% even within 6 hours. The areas of high signal on DWI were correlated with the degrees of perfusion deficits on CBV maps. The first NIHSS did not correlate with perfusion deficits, but the final NIHSS was correlated well with areas of high signal on DWI and final infarct areas. Conclusions CTP might be used as a routine test in diagnosing hyperacute hemisphere ischemia. The final neurological deficits should be well correlated with areas of high signal on DWI and final infarct areas.