超急性动脉闭塞性脑梗塞CT和DSA对比检查研究

A comparative study on CT and dSA in the diagnosis of the hyperacute cerebral infarction

目的 :了解CT和DSA各自对超急性脑动脉闭塞性脑梗塞的诊断价值及相互之间在影像学方面的关联。方法 :10例患者 ,临床上均因突发性失语、一侧肢体偏瘫、无明显神志障碍、且在发病 6h内就诊。所有患者均经神经内科医生检查 ,疑诊为脑梗塞后先行头部CT扫描 ,再行DSA检查 ,并在诊断明确的基础上进行动脉介入溶栓治疗。结果 :2例 4级脑动脉分支闭塞患者的CT和DSA检查结果基本相符 ;5例脑动脉主干闭塞的患者尽管CT发现脑梗塞灶 ,但其范围明显小于动脉的供血范围 ;1例DSA见动脉闭塞 ,但CT未见低密度改变 ;1例DSA见动脉闭塞 ,CT仅见局部脑肿胀改变 ;1例患者CT和DSA发病 6h内检查均为阴性 ,2 4h后CT复查见脑梗塞灶。结论 :DSA在显示脑动脉闭塞或狭窄方面具有较高的敏感性 ,CT只是在缺血脑组织的病理变化发展到一定阶段时才能检测出来。尽管如此 ,我们仍然认为CT是诊断急性缺血性脑梗塞的首选检查方法。DSA只是在进行动脉内介入溶栓治疗时予以使用。

Objective:To investigate the value and the relationship between CT and DSA in the diagnosis of hyper acute arterial obliterans cerebral infarction.Methods:10 patients with the sudden aphasia,hemiparalysis and consciousness underwent CT scanning and DSA within 6 hours at the onset following suspected cerebral infarction diagnosed by neurologist.once the diagnosis was confirmed by CT and DSA, the transarterial thrombolytic therapy was performed.Results:In 2 patients with the obliteration of the 4th branch of the trunk, CT agreed with the findings of DSA. In 5 patients with the obliteration of the trunk, the infarcted focus found on CT scans was much smaller than the area supplyed by the artery before obliteration. In patients,DSA showed the obliterated artery,but no low density lesion was found on CT image.The last patient had negative result on CT and DSA within 6 hours at the onset, however, the infarcted focus was docu mented 24 hours later on CT follow up.Conclusion:DSA is more sensitive to show the obliteration or the narrowing of the artery,but CT can't get positive result until the pathological change of the ischemic brain tissue has developed to some stage.All for this,we still consider that CT should be the first method of choice in the detection of the acute ischemic cerebral infarction, but DSA must be used when the transarterial thrombolytic therapy is necessitated.