CT血管造影联合CT脑灌注成像对老年患者急性脑梗死合并脑血管狭窄的诊断价值

Value of CT angiography combined with CT cerebral perfusion imaging in the diagnosis of cere-bral vascular stenosis in elderly patients with acute cerebral infarction

目的探讨CT血管造影联合CT脑灌注成像（CTP）对老年患者急性脑梗死合并脑血管狭窄的诊断价值。方法选取老年急性脑梗死合并脑血管狭窄患者30例，入院后均行颅脑CT扫描、CTP及CT血管造影（CTA）检查，重建处理获得的图像，测量病灶区域脑血流量（CBF）、脑血容量（CBV），并测量患者对侧未梗死、脑血管狭窄部位。结果急性脑梗死合并脑血管狭窄区域CBF、CBV均低于病灶周围区域与健侧对照区域（P均〈0．05）；病灶周围区域CBF高于健侧对照区域（P〈0．05）；病灶周围区域CBV低于健侧对照区域（P〈0．05）；病灶区域平均通过时间少于病灶周围区域（P〈0．05），长于健侧对照区域（P〈0．05）；病灶周围区域平均通过时间长于健侧对照区域（P〈0．05）；30例患者经颅脑CTA检查共查出43个狭窄部位，58．14％的狭窄部位为中度狭窄，27．19％为轻度狭窄；30例老年急性脑梗死合并脑血管狭窄患者中，CTP灌注异常区域与狭窄动脉供血26例符合，4例存在偏差，符合率为86．67％，具有良好的一致率。结论CTA联合CTP用于老年急性脑梗死合并脑血管狭窄患者中效果理想，可早期确诊，为临床治疗提供影像学依据，值得推广应用。

Objective To investigate the value of computed tomography （CT） angiography com- bined with CT perfusion imaging （CTP） in the diagnosis of cerebral vascular stenosis in elderly patients with acute cerebral infarction. Methods Thirty elderly patients with acute cerebral infarction complicat- ed by cerebral vascular stenosis were selected and were checked by CT, CTP and CT angiography （CTA）, then the images were reconstructed and processed; cerebral blood flow （CBF） in focual area and cerebral blood volume （CBV） were measured; and sites of contralateral non infarction and cerebral vascular stenosis were determined. Results CBF and CBV in the area of acute cerebral infarction com- plicated by cerebral vascular stenosis were lower than those in peripheral area of lesion and in healthy control area （ all P 〈 0. 05 ） ; CBF in peripheral area of lesion was higher than that in healthy control area （ P 〈 0. 05 ） ; CBV in peripheral area of lesion was lower than that in healthy control area （P 〈 0. 05 ） ; the average through time of lesion area was shorter than that of the peripheral area of lesion （P 〈 0. 05 ）, and was longer than that of the healthy control area （ P 〈 0.05 ） ; the average through time in peripheral area of leison was longer than that of healthy control area （P 〈 0. 05 ）. CTA detected 43 sites of stenosis in the 30 patients, of which 58.14% were moderate stenosis and 27. 19% were mild stenosis. Among the 30 elderly patients with acute cerebral infarction complicated by cerebral vascular stenosis, CTP abnormal perfusion areas are in line with blood supply of arterial stenosis in 26 cases, with 4 cases of deviation, the coincidence rate is 86.67%, with good consistency. Conclusions CTA combined with CTP is an ideal detection method for elderly patients with acute cerebral infarction and cerebral vascular stenosis. It can diagnose the disease early and provide imaging evidence for clinical treatment. It is worthy of populariza-tion and application.