全脑CT灌注成像结合头颈部CTA在急性缺血性脑卒中诊断中的价值研究

Value of Whole Brain CT Perfusion Imaging Combined with Head and Neck CTA in the Diagnosis of Acute Ischemic Stroke

目的研究全脑CT灌注成像(CTP)结合头颈部CT血管成像(CTA)在急性缺血性脑卒中(AIS)诊断中的价值。方法对我院294例疑似AIS患者依次进行CT平扫、CTP和CTA检查,计算CTP联合CTA诊断AIS灵敏度和特异度,测量CTP参数CBF、CBV、MMT和TTP,评价脑动脉血管狭窄程度,然后分析不同病变程度脑组织CBF、CBV、MMT和TTP变化情况及其与脑动脉血管狭窄程度的相关性。结果共294例患者中最终确诊为AIS者253例(86.05%),CTP联合CTA诊断灵敏度和特异度分别为85.37%和92.68%;CTP检查发现明显灌注异常者207例,其中梗死灶194处、半暗带182处,两者同时存在173处,且梗死区CBF、CBV低于对照区和半暗带,MTT、TTP高于对照区和半暗带,差异有统计学意义(P<0.05),半暗带CBF低于对照区,MTT和TTP高于对照区,差异有统计学意义(P<0.05);经Pearson相关系数分析,颈内动脉和颅内动脉狭窄程度与CBF、CBV无明显相关性(P>0.05),与MTT呈负相关性(P<0.05),与TTP呈正相关性(P<0.05),但相关程度均较低。结论 CTP检查可有效评估脑组织血流动力学变化和缺血严重程度,并准确区分梗死区和半暗带,CTA则可准确检测脑动脉血管狭窄部位和程度,两种方法联合应用不仅可对AIS进行准确诊断,同时还可评估病情及疗效,为临床选择合理治疗方案提供影像依据。

Objective To study the value of whole brain CT perfusion imaging(CTP)combined with head and neck CT angiography(CTA)in the diagnosis of acute ischemic stroke(AIS).Methods A total of 294 cases of patients with suspected AIS in our hospital were given CT plain scan,CTP and CTA respectively.The sensitivity and specificity of CTP combined with CTA was analyzed.The CTP parameters of CBF,CBV,MMT and TTP were measured,and the degree of cerebral artery stenosis was evaluated.And the changes of CBF,CBV,MMT and TTP in brain tissue of different lesions and their correlation with the degree of cerebral artery stenosis were analyzed.Results Of 294 patients,253 cases(86.05%)were diagnosed as AIS.The sensitivity and specificity of CTP combined with CTA were 85.37%and 92.68%respectively.The CTP examination revealed 207 cases of obviously abnormal perfusion,including 194 infarcts,182 penumbra and 173 of existence simultaneously,and the CBF and CBV in infarct area were lower than those in control area and penumbra while the MTT and TTP were higher than those in control area and penumbra(P﹤0.05).The CBF in penumbra was lower than that in control area while the MTT and TTP were higher than those in control area(P﹤0.05).Pearson correlation coefficient analysis showed the degree of internal carotid artery and intracranial artery stenosis was not significantly correlated with CBF and CBV(P﹥0.05),and negatively correlated with MTT(P﹤0.05),and positively correlated with TTP(P﹤0.05),but the correlation degree was low.Conclusion CTP can effectively assess the hemodynamic changes and ischemic severity of brain tissue,and distinguish the infarct zone and penumbra accurately.CTA can accurately detect the location and degree of cerebral artery stenosis.The combination of the two methods can not only be used for accurate diagnosis of AIS,but also for assessment of condition changes,so as to provide images support for clinically treatment regimens selection.