“一站式”多模态CT在急性缺血性脑卒中的应用

Application of acute ischemic stroke by “one-stop” multi-modality CT

目的“一站式”多模态CT中CT脑灌注成像可反映脑梗死患者脑组织血流异常灌注情况,CT脑血管成像可明确头颈部血管狭窄、闭塞等状况。本文探讨“一站式”多模态CT对急性缺血性脑卒中的诊断价值。方法连续选取2015年6月~2017年12月发病4.5~24h内在我院神经内科住院并经磁共振成像(MRI-DWI)检查确诊、但未行静脉溶栓及支架取栓的96例急性脑梗死患者作为研究对象,对患者进行脑“一站式”多模态CT扫描检查,用CT灌注软件和血管软件进行评估,观察并比较CT灌注成像(CTP)各参数,分析供血动脉狭窄程度与脑灌注异常的关系。结果①急性缺血性脑卒中诊断以MRI检查作为标准,头颅CT平扫的精确度为39.6%,多模态CT的精确度为93.8%。②CTP灌注异常的90例患者中,有38例存在缺血半暗带。无论是梗死核心区还是缺血半暗带区,脑梗死侧灌注参数脑血流量(CBF)均低于对侧镜像区,而平均通过时间(MTT)、达峰时间(TTP)值长于对侧镜像区,梗死核心区的脑血容量(CBV)值明显低于梗死镜像区,差异有统计学意义(P<0.05);而52例CTP无缺血半暗带的脑梗死患者中,除参数CBV外,其余参数与对侧镜像区比较,差异均有统计学意义(P<0.05)。③CT血管成像(CTA)能有效评估供血动脉狭窄程度及部位等,灌注异常区与供血动脉狭窄程度之间有关系(P<0.05)。结论脑“一站式”多模态CT检查具有简单、快速的特点,可同时观察急性脑梗死血流动力学改变并分析病变区供血动脉情况,有利于急性脑梗死的早期诊断,更有利于个体化的治疗。

Objective The perfusion imaging of "one-stop" multi-modality CT can reflect the abnormal perfusion of cerebral tissue in patients with cerebral infarction,while the CT cerebral angiography can clarify the vascular stenosis or occlusion in head and neck.In this paper,to discussed the value of "one-stop" multi-modal CT in the diagnosis of acute ischemic stroke.Methods A total of 96 patients with acute ischemic stroke within 4.5 to 24 h and admitted to the department of neurology in our hospital from June 2015 to December 2017 were selected as subjects.All participants were confirmed by magnetic resonance-diffusion-weighted imaging (MRI-DWI),but did not receive intravenous thrombolysis or embolectomy.The patients were examined by the "one-stop" multi-modal CT scan of the brain.The parameters of CT perfusion imaging (CTP) were observed and compared,and the relationship between the vascular stenosis and cerebral perfusion abnormality was analyzed by CT perfusion and vascular software.Results ①MRI was taken as the gold standard for acute ischemic stroke.The accuracy of NCCT scan was 39.6%,and the accuracy of multimodal CT was 93.8%.②For 90 patients with abnormal CTP perfusion,there were 38 cases with the ischemic penumbra.Both in the infarct core area and the ischemic penumbra,they had lower values of cerebral blood flow (CBF) in cerebral infarction side than in the contralateral mirrored area,the mean transit time (MTT) and time to peak (TTP) values were longer than the values in the contralateral mirrored area,the cerebral blood volume (CBV) in the infarct core area was significantly lower than that in the infarct mirror area,the differences were statistically significant (P<0.05).However,for other 52 patients without the ischemic penumbra,values of all parameters except for CBV in cerebral infarction side were significantly different from the values in the contralateral mirrored area (P<0.05).③CTA could effectively evaluate the degree and location of arterial stenosis,there was a relationship between the abnormal perfusion area and the degree of arterial stenosis (P<0.05).Conclusion The “one stop” multi-modal CT examination of the brain is simple and rapid.It can demonstrate the hemodynamic changes and the morphology of the vessels in ACI patients,which is conducive to the early diagnosis of acute cerebral infarction,and is more conducive to individualized therapy.