256层螺旋CT一站式全脑灌注与CTA评估急性脑梗死的价值

Value of full brain 256-slice spiral CT perfusion imaging combined with CTA in acute brain infarction

目的旨在探讨全脑CT灌注成像+CTA一站式扫描评估急性脑梗死的应用价值。方法对29例急性脑梗死患者行全脑灌注成像。选取动脉期数据重建脑动脉三维和二维图像,观察脑动脉狭窄、闭塞情况。分别取脑梗死灶中央区、周边区及对侧相应脑白质;病变侧正常脑白质与健侧对应部位脑白质作为兴趣区,测量CBV、CBF、MTT和TTP,比较病变侧及健侧测量值。结果 29例患者梗死区供血血管狭窄、闭塞和分支减少26例。梗死中央区TTP和MTT明显延长,CBV和CBF明显下降,与对侧比具有显著性差异(P<0.01)。周边区TTP和MTT延长,CBV增高,CBF下降。与对侧比较具有显著性差异(P<0.05)。测量患侧正常脑白质和健侧对应脑白质的CBV、CBF、TTP和MTT的值,CBV、CBF增高,MTT缩短,数据具有显著性的差异(P<0.05)。结论多层螺旋CT全脑灌注联合CTA一站式扫描方法简便,能较全面显示血管形态与脑组织微循环状态,对脑组织存活状态的定性敏感性高,为评估急性脑梗死有价值的方法。

Objective To determine the value of full brain CT perfusion imaging （CTPI） combined with CT angiography （CTA） in estimating acute brain infarction. Methods Full brain CTPI was performed on 29 patients with acute brain infarction. The arterial phase data were used for CTA reformatting. Brain arterial narrowing and obstruction were observed. Regions of interest （ROI） were selected in the center and perimeter of infarction as well as the contralateral normal brain. CBV, CBF, MTT and TTP of ROIs were compared. Results In 26/29 patients, CTA showed cerebral arterial narrowing, obstruction, or reduced arterial branches. In the center of infarction, TIP and MTT were significantly prolonged whereas CBV and CBF were significantly reduced （P 〈 0.01）. In the brain around infarction, there were significantly prolonged TTP and MTT, increased CBV and decreased CBF （P 〈 0.05）. The CBV and CBF of apparently healthy ipsilateral brain were significantly higher and the MTT significantly shorter than the contralateral brain （P 〈 0.05）. Conclusion CTPI combined with CTA is a simple and valuable method for diagnosing acute brain infarction. It clearly displays cerebral arteries and microcireulation with high sensitivity for assessing viability of brain.