脑CT灌注成像和血管成像术在海岛医院中的应用价值

The application value of CT perfusion imaging and CT angiography in island hospitals

目的探讨海岛医院应用CT灌注成像（CT perfusion imaging，CTPI）和CT血管成像（CT angiography，CTA）对超早期脑梗死诊断的应用价值。方法采用四排螺旋CT对24例突发偏瘫或失语、发病时间少于6h、CT检查阴性的患者，即行CTPI和CTA检查，定量分析病灶侧灰质区及皮层区的脑血流量（cerbral blood flow，CBF）、脑血容量（cerebral blood volume，CBV）、达峰时间（time to peak，TTP），并与对侧相应部位进行比较。在第2天及第7天行CT及MRI复查，对照观察CTPI和CTA的诊断价值。结果24例入选病例中4例CTA检查诊断为短暂性脑缺血发作（transient ischemic attack，TIA），其余20例中右侧颈内动脉段梗塞3例，右侧大脑中动脉主干支梗塞4例，右侧大脑中动脉分支梗塞8例，左侧大脑中动脉主干支梗塞3例，左侧大脑中动脉分支梗塞1例，左大脑后动脉主干支梗塞1例。上述病例在第2天、第7天在CT或MRI检查中均被证实，诊断符合率100％。脑梗死（cerebral infarction，CI）患侧的灰质CBF、灰质与白质CBV明显低于对侧（均P〈0．05）。CI组患侧脑白质区及灰质区的CBV明显低于TIA组（均P〈0．05）。结论联合进行头颅CT平扫、CTPI和CTA检查，有助于临床超早期识别CI、TIA；患侧脑白质区及灰质区的CBV状态是识别CI较为敏感的指标；CTA图像能敏感反映是否存在血管阻塞，是区分TIA与CI的可靠指标。

Objective To evaluate the value of combined application of computed tomography perfusion imaging （CTPI） and computed tomography angiography （ CTA ） in the diagnosis of superacute ischemic cerebrovascular disease in island hospitals. Methods Twenty-four patients doubted with cerebral infarction with routine CT positive, results underwent CTPI and CTA within 6 hours. CTPI with cerebral blood flow（CBF） , cerebral blood volume （CBV） and time to peak （TTP） was observed and evaluated . All cases were followed-up with CT or MRI after 2 to 7 days. Results In 24 cases, four cases were diagnosed as TIAs. In other 20 cases, three cases were infarcted at R-PCA , 4 cases at trunks of R-MCA ,8 cases at branches of R- MCA, 1 cases at L-PCA, 3 cases at trunk of L-MCA and 1 case at branch of L-MCA. M1 diagnosis were confirmed by CT or MRI after 2 to 7 days. The CBF and CBV at gray matter and the CBV at white matter in ischemic region were lower than that in the opposite corresponding region（ P 〈 0.05 ）. The CBV at gray matter and white matter in ischemic region in cerebral infarction patients were lower than that in TIAs patients （ P 〈 0. 05）. Conclusions Combined application of CT, CTPI and CTA can detect hyperacute ischemic lesion at earlier stage. It is helpful in differentiating TIAs from cerebral infarction.