CTPI联合CTA在TIA发病机制研究及诊断中的应用价值

Application value of CT perfusion imaging combined with CT angiography for pathogenesis determination and diagnosis of transient ischemic attack

目的 :探讨CT灌注成像(CT perfusion imaging,CTPI)与CT血管造影(CT angiography,CTA)联合应用在短暂性脑缺血(transient ischemic attack,TIA)发病机制研究及诊断中的价值。方法:选取2014年4月至2016年4月医院神经内科收治的50例TIA患者,依次行CT平扫、CTPI及CTA检查,计算患者脑部感兴趣区健侧及患侧脑血容量(cerebral blood volume,CBV)、脑血流量(cerebral blood flow,CBF)、平均通过时间(mean transit time,MTT)及峰值时间(time to peak,TTP)。分析TIA患者脑血流灌注状态与脑血管狭窄的关系。结果:50例TIA患者患侧CBF、CBV水平低于健侧(P<0.05),而MTT、TTP水平高于健侧(P<0.05);CT平扫、CTPI及CTA检查发现与临床一致的脑灌注异常分别为28例(56.00%)、45例(90.00%)、38例(76.00%),三者TIA阳性诊断率差异有统计学意义(P<0.05)。结论:颈动脉系统低血流灌注是TIA患者发病的机制之一,CTPI阳性率与TIA病情有密切关系。CTPI联合CTA在TIA患者临床诊断中具有较高的应用价值,可作为TIA个性化诊疗依据。

Objective To investigate the application value of CT perfusion imaging（CTPI） combined with CT angiography（CTA） for determination and diagnosis of transient ischemic attack（TIA）. Methods Totally 50 TIA patients from April 2014 to April 2016 in the neurology department of some hospital underwent examinations by CT scan, CTPI and CTA in time, and the values of cerebral blood volume（CBV）, cerebral blood flow（CBF）, mean transit time（MTT） and time to peak（TTP） were calculated at the uninjured and injured sides of the areas of interest. The relationship between cerebral blood perfusion and cerebral angiostenosis of the TIA patient was analyzed. Results The 50 patients had the values of CBF and CBV at the injured sides lower while the ones of MTT and TTP higher than those at the uninjured sides（P 0.05）. The numbers of the abnormal cerebral blood perfusion patients found by CT scan, CTPI and CTA were 28（56.00%）, 45（90.00%） and 38（76.00%）respectively, who were confirmed clinically simultaneously. There were significant differences between the TIA positive result rates by CT scan, CTPI and CTA（P 0.05）. Conclusion Carotid artery hypoperfusion is one of the pathogeneses of TIA, and positive rate by CTPI is closely related to the conditions of TIA. CTPI combined with CTA contributes to the diagnosis of TIA, and can be used for its individualized treatment.