多层螺旋CT脑灌注成像联合头颈部CT血管成像在分水岭脑梗死的应用

Combination of cerebral CT perfusion and CT angiography in the evaluation of cerebral watershed infarction

目的探讨多层螺旋CT脑灌注成像联合头颈部CT血管成像在分水岭脑梗死的应用价值。方法30例分水岭脑梗死患者进行脑CT灌注联合头颈部血管成像(CTA)扫描检查。结果 CT脑灌注显示21例在分水岭脑梗死区周围出现异常灌注;与对侧比较脑血流量(CBF)、平扫通过时间(MTT)及峰值时间(TTP)差异有统计学意义(P<0.01),脑血容量(CBV)差异无统计学意义(P>0.05)。CTA示17例头颈部血管重度以上狭窄,责任血管数合计24支,其中大脑中动脉重度狭窄12处,颈内动脉6处,大脑后动脉4处,椎动脉2处。脑梗死区周围出现异常灌注有15例头颈部血管重度狭窄,无异常灌注组只有2例合并重度狭窄,两者有统计学差异(χ2=6.21,P<0.05)。结论 CT脑灌注成像联合CTA检查具有安全、无创、简便的检查方法,通过一次性检查即可全面评价分水岭脑梗死的脑血流动力学参数及其头颈部动脉狭窄的情况,为临床医师尽早进行合理的治疗提供影像学依据。

Objective To study the clinical diagnosis value of the combination application of CT perfusion and CT angiography on cerebral watershed infarction. Methods Thirty patients of cerebral watershed infarction were examined with CTP and CTA. Results CT brain perfusion showed 21 cases of abnormal perfusion outside the watershed infarction area. Compared with the contralateral cerebral blood flow（CBF）, plain scan through time（MTT） and peak time（TTP） difference was statistically significant（P〈0.01）, cerebral blood volume（CBV） was not statistically significant（P〉0.05）. Among the patients,neck or cerebral artery stenosis occurred in 17 cases diagnosed by CTA. CT angiography found 24 branches with responsible vascular stenosis, including MCA stenosis in 12 branches and ICA stenosis in 6 branches and PCA stenosis in 4 branches and VA stenosis in 2 branches. Abnormal perfusion appears around the cerebral infarcted area there were 15 cases of head and neck vascular stenosis, abnormal perfusion only 2patients with severe stenosis, there is a significant difference between the abnormal perfusion group and the no abnor-mal group（χ^2=6.21,P〈0.05）. Conclusion CT Perfusion Imaging combined with CTA is safe, non-invasive, simple method, by screening only once in order to estimate parameters of cerebral hemodynamics of cerebral watershed in-farction and its head and neck artery stenosis, for clinicians provide imaging evidence reasonable treatment as soon as possible.