CT脑灌注成像在基底节区腔隙性脑梗死的初步应用

The Preliminary Study of CT Cerebral Perfusion Imaging on Basal Ganglia Lacunar Infarction

目的探讨CT脑灌注成像在基底节区腔隙性脑梗死的应用价值。资料与方法对35例超早期(发病<6 h)基底节区腔隙性脑梗死患者行常规CT头颅平扫及CT脑灌注成像。在常规轴位CT扫描后选取基底节区层面,经肘静脉团注45 ml非离子型对比剂,同时开始持续40 s的单层连续动态扫描,重组的40幅动态图像使用CT脑灌注软件进行处理,获得灌注图像。测量双侧基底节区感兴趣区的局部脑血流量(CBF)及局部灌注达峰时间(TTP),并进行定量分析。结果35例基底节区腔隙性脑梗死患者中有29例被后期追踪CT或MRI证实为基底节区腔隙性脑梗死,其中20例梗死灶直径>5 mm(<20 mm),9例病灶<5 mm;余6例CT复查为阴性而临床诊断为脑梗死。20例梗死灶直径>5 mm(<20 mm)中有17例CT灌注为阳性,表现为CBF明显低于正常侧,TTP明显长于正常侧;另外3例未发现灌注异常区。20例梗死灶直径>5 mm(<20 mm)患者患侧及对侧的局部灌注平均CBF分别为(384.9±118.7)ml.min-1.L-1和(256.2±80.3)ml.min-1.L-1,两者比较差异有统计学意义(t=5.898,P<0.01);患侧及对侧的局部平均TTP分别为(12.8±3.4)s和(9.6±3.8)s,双侧对比差异亦有统计学意义(t=7.104,P<0.01)。9例病灶<5 mm患者中,仅2例CT灌注为阳性,患侧及对侧局部灌注平均CBF分别为(448.0±137.8)ml.min-1.L-1和(422.2±229.6)ml.min-1.L-1,两者比较差异无统计学意义(t=0.664,P>0.5);患侧及对侧局部平均TTP分别为(10.1±2.0)s和(9.3±1.3),两侧之间差异无统计学意义(t=1.039,P>0.5)。结论CT脑灌注成像能为基底节区腔隙性脑梗死提供有价值的脑血流动力学信息,为临床超早期诊断和治疗提供依据。

Objective To discuss the application value of CT cerebral perfusion imaging on basal ganglia lacunar infarction.Materials and Methods Brain CT plain scan and CT perfusion were performed in 35 patients suspected of superacute（less than 6 hours）basal ganglia lacunar infarction.The basal ganglia slice was selected and injection of bolus 45 ml non-ionic contrast material through antecubital vein was done,the single layer continuous dynamic scan for persistent 40 seconds started,reconstructed 40 images of dynamic image were processed by ＂Perfusion CT＂ software.Regional cerebral blood flow and regional perfusion time to peak of double basal ganglia for interest were analyzed.Result There were 29 cases verified as basal ganglia lacunar infarction by following up CT or MRI scanning in 35 cases of basal ganglia lacunar infarction.There were 20 cases with size of infarction lesion more than 5 mm（less than 20 mm）,9 cases with size of infarction lesion less than 5 mm,other 6 cases with infarction were negative on CT whilie clinically diagnosed as cerbral infarction.Among these 20 cases with size of infarction lesion more than 5 mm（less than 20 mm）,17 cases had positive results on CT perfusion,which cerebral blood flow obviously decreased and perfusion time to peak obviously increased,and nomal perfusion was in other 3 cases.The CBF in affected side and contralateral side were（384.9±118.7） ml·min-1·L-1 and（256.2±80.3） ml·min-1·L-1 respectively,which was significantly difference（t=5.898,P〈0.01）,the TTP in affected side and contralateral side were（12.8±3.4） s and（9.6±3.8） s respectively,which was significantly difference（t=7.104,P〈0.01）.Among the 9 cases with size of infarction lesion less than 5 mm,only 2 cases had positive results on CT perfusions,The CBF in affected side and contralateral side were（448.0±137.8） ml·min-1·L-1 and（422.2±229.6） ml·min-1·L-1 respectively,which was not significantly difference（t=0.664,P〈0.5）,the TTP in affected side and contralateral side were（10.1±2.0） s and（9.3±1.3） s respectively,which was also not significantly difference（t=1.039,P〉0.5）.Conclusion CT cerebral perfusion imaging can provide valuable information of cerebral hemodynamics for basal ganglia lacunar infarction,it is helpful to early diagnosis and treatment.