64排螺旋CT脑灌注成像对早期脑梗死的诊断价值

Diagnostic Value of Brain Perfusion Imaging with 64 Multi-Detector Spiral CT in Early Cerebral Infarction

目的:探讨64排螺旋CT脑灌注成像(CT perfusion imaging,CTP)对早期脑梗死的诊断价值。方法:临床拟诊早期脑梗死患者38例,均在症状出现24 h内行头颅CT平扫及CTP检查。将脑梗死核心区、缺血半暗带(ischemic penumbra,IP)区与健侧对应区的情况做对比分析。结果:38例患者中,15例头颅CT平扫发现可疑脑梗死区,主要位于大脑半球,表现为密度轻度减低、局部脑沟稍变浅等;其余23例患者CT平扫未发现异常。38例患者的CTP检查均发现灌注异常区,表现为脑梗死区脑血流量(cerebral blood flow,CBF)与脑血容量(cerebral blood volume,CBV)均较健侧对应区明显下降,对比剂平均通过时间(mean transit time,MTT)较健侧对应区缩短,对比剂达峰时间(time to peak,TTP)较健侧对应区明显延长,差异均有统计学意义(P<0.01)。早期脑梗死患者IP区与梗死核心区比较,CBF、CBV、MTT及TTP差异均有统计学意义(P<0.01);IP区与健侧对应区比较,CBF、MTT、TTP差异均有统计学意义(P<0.05、0.01),CBV差异无统计学意义(P>0.05)。获得随访的18例患者中,经积极溶栓等治疗后梗死区缩小6例,梗死区消失5例,仅表现为梗死区TTP和MTT延长、CBF和CBV变化不大3例,梗死区无明显变化4例。结论:64排螺旋CTP检查可以准确地提示早期脑梗死。

Objective：To explore the diagnostic value of CT perfusion imaging（CTP）with64 multi-detector spiral CT in early cerebral infarction.Methods：A total of 38 patients with suspected early cerebral infarction underwent plain CT and CTP within24 h after the onset of related symptoms.The imaging results in infarction core area,ischemic penumbra（IP）and the contralateral normal region were comparatively analyzed.Results：Early cerebral infarction,mainly in cerebral hemispheres,were suspected in 15 patients of the total 38 patients with plain CT.The performance was light reduction of lesion density and slightly shallowing in local sulci.The plain CT results in the other 23 patients didn＇t showed abnormal performance.Abnormal perfusion area were found in all 38 patients with CTP.Comparing with that in contralateral normal region,the imaging results in abnormal perfusion area showed significant decline of cerebral blood flow（CBF）and cerebral blood volume（CBV）,shortening of mean transit time（MTT）and significant extension of time to peak（TTP）.All the differences showed statistical significant differences（P〈0.01）.There were significant differences in CBF,CBV,MTT,TTP between the infarction core area and IP（P〈0.01）.And there were significant differences in CBF,MTT,TTP（P〈0.05 and 0.01）between IP and the contralateral normal region while there was none in CBV（P〉0.05）.Among the 38 cases,18 patients were followed up after active thrombolytic therapy.Infarction area reduced in 6 patients and disappeared in 5 patients.Three cases showed only extension of TTP and MTT and little change of CBF and CBV.Four cases had no changes in infarction area.Conclusions：CTP with64 multi-detector spiral CT can accurately prompt the diagnosis of early cerebral infarction.