CT灌注成像在超早期脑梗死中的应用

Application of CF perfusion in hyperacute cerebral infarction

目的 探讨CT灌注成像（CT perfusion,CTP）在超早期脑梗死诊断和鉴别诊断中的作用.方法 33例发病＜5 h临床诊断为脑梗死的患者行CT平扫后,再行CTP,24 h后复查CT.结果 33例患者基线CT平扫均未见异常.CTP显示15例正常,18例异常.CTP正常者病灶侧局部脑血流量（regional cerebral blood flow,rCBF）、局部脑血容量（regional cerebral blood volume,rCBV）和局部平均通过时间（regional mean transit time,rMTT）分别为（32.588±5.877）ml/（100 g·min）、（1.205±0.261）ml/100 g和（2.937±0.887）s,与健侧的（33.208±6.740）ml/（100 g·min）、（1.233±0.290）ml/100 g和（2.854±0.799）s无显著差异（P均＞0.05）;经临床追踪和复查CT证实,11例确诊为短暂性脑缺血发作、2例为低血糖、2例为脑干梗死.18例CTP异常患者病侧rCBF、rCBV和rMTT分别为（6.580±3.457）ml/（100 g·min）、（0.803±0.285）ml/100 g和（14.947±4.665）s,与健侧的（34.756±4.126）ml/（100 g·min）、（1.622±0.708）ml/100 g和（3.794±1.775）s差异显著（P均＜0.05）;临床追踪和复查CT证实为基底节区脑梗死.结论 CTP可用于超早期脑梗死诊断,且具有鉴别诊断的意义.

Objective To investigate the role of computed tomography perfusion （CTP） in the diagnosis and differential diagnosis of hyperacute cerebral infarction. Methods After CT scan was performed in 33 patients who were clinically diagnosed as cerebral infarction 〈 5 hours of symptom onset, CTP imaging was performed. CT was reexamined after 24 hours. Results CT scan did not find abnormality in 33 patients. CTP imaging showed 15 were normal and 18 were abnormal. The regional cerebral blood flow （rCBF）, regional cerebral blood volume （rCBV）, and regional mean transit time （rMTT） in patients with normal CTP imaging were 32. 588± 5. 877 ml/（100 g · min）, 1.205 ± 0.261 ml/100 g, and 2.937 ± 0.887 s, respectively. There were no significant differences compared to the contralateral sides （33.208 ± 6. 740）ml/（100 g - min）, 1.233 ±0.290） ml/100 g, and 2. 854±0.799 s） （all P 〉0.05）. Clinical follow up and CT reexamination confirmed that 11 patients were diagnosed as transient ischemic attack （TIA）, 2 were hypoglycemia, and 2 were brain stem infarction. The rCBF, rCBV, and rMTT in the ipsilateral sides of 18 patients with CTP imaging abnormality were 6. 580 - 3. 457 ml/（100 g · min）, 0. 803 ±0. 285 ml/100 g, and 14.947 ±4. 665 s, respectively. There were significant differences corroded to the contmlateral sides （34. 756 ±4. 126 ml/（100 g · min）, 1. 622±0. 708 ml/100 g, and （3.794± 1. 775 s） （all P 〈0.05）. Clinical follow up and CT reexamination confmned as cerebral infarction in the basal ganglia region. Conclusions CIP imaging can be used for the diagnosis of hyperacute cerebral infarction and has the significance of differential diagnosis.