64层螺旋CT在急性脑卒中“一站式”检查方案中的应用

Comprehensive imaging of hyperacute stroke with 64 multislice spiral CT

目的评价64层螺旋CT平扫、脑灌注成像（CTP）、CT血管造影（CTA）对急性脑卒中的应用价值。方法回顾性分析2006年1月至9月宣武医院神经内科71例急诊脑卒中患者，均于发病6h内行64层螺旋Cr检查，平扫排除出血患者，行CTP及CTA检查，分析平扫、CTP及CTA表现。结果71例中5例CT平扫脑出血。30例随访为脑梗死患者中20例平扫无异常，CTP均发现灌注异常，表现脑血流量（CBF）明显减低，脑血容量（CBV）轻度减低，达峰时问（TTP）明显延迟；梗死区CBF、CBV与对侧差异具有统计学意义（P〈0．01），半暗带区CBF、TT与对侧差异具有统计学意义（P〈0．01），而CBV差异无统计学意义（P〉0．05）；CTA显示20例一侧大脑中动脉（MCA）重度狭窄或闭塞，10例一侧颈内动脉（ICA）重度狭窄或闭塞。36例随访为短暂性脑缺血发作（TIA），其中26例发现与临床症状相对应的灌注异常，表现为TTP延迟；另外10例未发现灌注异常区；病变侧与对侧TTP差异具有统计学意义（P〈0．01），病变侧与对侧CBF、CBV差异无统计学意义（P〉0、05）；CTA显示11例一侧ICA重度狭窄或闭塞，15例一侧MCA重度狭窄或闭塞，10例未发现异常。数据经SPSS统计软件两组独立样本秩和检验处理。结论CT平扫能够排除出血；CTP能够早期快速、准确反映缺血部位及程度，预测半暗带；CTA显示病变血管的部位和程度；64层螺旋CT对早期诊断脑卒中和指导治疗有重要价值。

Objective To evaluate the application of 64 muhislice spiral CT plain, cerebral perfusion imaging （CTP） and CT angiography （CTA） in patients with hyperacute stroke. Method Cerebral plain CT, CTP and CTA were performed on 71 patients with hyperacute stroke within 6 hours. Quantitative analysis of CTP parameters was performed. CT angiography was constructed to show carotid and intracerebral artery. Results Five cases CT plain were cerebral hemorrhage. Abnormal perfusion changes were found in 30 cases of infarction, include cerebral blood flow （CBF） and cerebral blood volume （CBV） decreased, time to peak （TTP） delayed. There were significant differences of CBF, CBV and TIP between ipsilateral and contralateral side （ P 〈 0.01 ）. CTA demonstrated stenosis or occlusion of middle cerebral artery （MCA） and internal carotid artery （ICA）. Prolonged TTP was found in 26 cases with transient ischemic attacks （TIA）. Other 10 cases were normal. TTP of affected side was significantly delayed （ P 〈 0.0l ）. The differences of the CBF and CBV were not statistically significant between affected side and contralateral side. CTA demonstrated stenosis or occlusion of MCA and ICA in 26 cases with prolonged TIP. Conclusions CT plain could exclude cerebral hemorrhage, CTP and CTA could early show the ischemic extent and penumbra, the stenosis or occlusion of artery respectively in patients with hyperacute stroke.