短暂性脑缺血发作患者的CT灌注成像：前瞻性病例系列研究

CT perfusion imaging in patients with transient ischemic attack： a prospective case series study

目的 探讨短暂性脑缺血发作（transient ischemic attack,TIA）患者CT灌注成像（CT perfusion,CTP）变化以及出现CTP异常的危险因素.方法 纳入TIA行CTP和CT血管造影检查的患者.获得脑血流量（cerebral blood flow,CBF）、脑血容量（cerebral blood volume,CBV）、平均通过时间（mean transit time,MTT）和达峰时间（time to peak,TTP）等参数值,通过与对侧镜像区进行比较确定CTP异常.对CTP异常组与正常组人口统计学和基线临床资料进行比较,采用多变量logistic回归分析确定TIA患者出现CTP异常的危险因素.结果 共纳入69例TIA患者,其中52例存在与临床症状相对应的灌注异常,表现为TTP和MTT延长,但CBF和CBV下降不明显.多变量logistic回归分析显示,国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分较高[优势比（odds ratio,OR）1.991,95％可信区间（confidence interval,CI）1.113 ～3.564；P=0.020]、症状持续时间较长（OR l.062,95％ CI l.013～1.114；P=0.013）以及伴有颅内血管狭窄（OR 15.410,95％ CI2.118 ～112.116；P=0.007）是TIA患者出现CTP异常的独立危险因素.相关性分析显示,TTP延长（r=0.389,P=0.001）和MTT延长（r=0.413,P=0.001）与NIHSS评分显著相关.结论 TTP和MTT能敏感地显示TIA患者的脑灌注异常,病情越严重,CTP异常率越高.

Objective To investigate the changes of CT perfusion （CTP） imaging and the risk factors for CTP abnormality in patients with transient ischemic attack （TIA）.Methods TIA patients were enrolled; CTP and CT angiography were performed.The parameter values of cerebral blood flow （CBF）,cerebral blood volume （CBV）,mean transit time （MTT）,and time to peak （TTP） were obtained.CTP abnormalities were identified by comparing the contralateral mirror area.Demography and baseline clinical data were compared in a CTP imaging abnormal group and a normal group.Multivariate logistic regression analysis was used to identify the risk factors for CTP abnormality in patients with TIA.Results A total of 69 patients with TIA were enrolled,and 52 of them had perfusion abnormalities corresponding to clinical symptoms.Their TTP and MTT were prolonged,but the decreased CBF and CBV was not obvious.Multivariate logistic regression analysis showed that the higher National Institutes of Health Stroke Scale （NIHSS） score （odds ratio [OR] 1.991,95% confidence interval [OR] 1.113-3.564; P=0.020）,the longer duration of symptoms （OR 1.062,95% OR 1.013-1.114; P =0.013）,and intracranial vascular stenosis （OR 15.410,95% OR 2.118-112.116; P=0.007） were the independent risk factors for CTP abnormality in patients with TIA.The correlation analysis showed that the prolonged TTP （r =0.389,P =0.001） and MTT （r =0.413,P=0.001） were significantly associated with the NIHSS score.Conclusions TTP and MTT may sensitivity reveal cerebral perfusion abnormalities in patients with TIA.The more severe the disease is,the higher the CTP abnormal rate will be.