低剂量灌注CT评估缺血性脑卒中恢复期预后的应用价值

The value of low dose perfusion CT in evaluating the prognosis of ischemic stroke in recovery period

目的探讨常规CT与灌注CT评估缺血性脑卒中恢复期预后的应用价值,明确低剂量灌注CT的应用优势。方法将绍兴市人民医院2018年5月-2019年5月诊治的80例缺血性脑卒中恢复期患者纳入研究,所有患者均行常规CT扫描与灌注CT扫描,按照灌注扫描不同剂量将其分为常规剂量组(行常规剂量灌注CT扫描)与低剂量组(行低剂量灌注CT扫描),每组40例,对比2组检查结果,分析低剂量灌注CT检查在预后评估中的应用价值。结果 80例患者中,经常规CT扫描均检出陈旧性梗死灶;灌注CT检查检出陈旧性梗死灶57例,其中常规剂量灌注CT检出28例,低剂量灌注CT检出29例。2组梗死中心区与缺血区的脑血流量、脑血容量、平均通过时间、局部灌注达峰时间比较均无差异(均P>0.05)。低剂量灌注CT检查,缺血区脑血流量、脑血容量[(0.79±0.30)mL/(min·g)、(0.93±0.22)mL/g]均大于梗死中心区[(0.22±0.19)mL/(min·g)、(0.27±0.13)mL/g],且平均通过时间、局部灌注达峰时间[(12.7±3.1)s、(22.1±4.0)s]均少于梗死中心区[(18.8±3.9)s、(24.4±3.7)s],差异有统计学意义(t=10.152、16.335、7.744、2.670,均P<0.05)。低剂量组的辐射剂量[(1.50±0.27)mSv]明显低于常规剂量组[(3.48±0.61)mSv],差异有统计学意义(t=18.772,P<0.001)。结论灌注CT有助于评估缺血性脑卒中恢复期患者的预后,可准确评价缺血区局部血流灌注改善程度,且低剂量灌注CT检查可降低辐射剂量,对临床诊治具有重要的指导意义。

Objective To explore the application value of routine CT and perfusion CT in evaluating the prognosis of ischemic stroke in recovery period, and to clarify the application advantage of low dose perfusion CT. Methods A total of 80 patients in the recovery period of ischemic stroke diagnosed and treated in our hospital from May 2018 to May 2019 were included in the study by retrospective analysis. All patients underwent routine CT scan and perfusion CT scan. At the same time, according to different doses of perfusion scan, they were divided into routine dose group and low-dose group with 40 cases in each group. The results of the two groups were compared, and the prognosis evaluation of low-dose perfusion CT was analyzed. Results The old infarcts were detected by regular CT scan in 80 patients. The old infarcts were detected by perfusion CT in 57 patients, including 28 by conventional dose perfusion CT and 29 by low dose perfusion CT. There was no significant difference between the two groups in the detection of cerebral blood flow, cerebral blood volume, mean transit time and local perfusion peak time in infarct center and ischemic area(all P>0.05). Under low dose perfusion CT examination, the detection values of cerebral blood flow and cerebral blood volume in ischemic area [(0.79±0.30) mL/(min·g),(0.93±0.22) mL/g] were higher than those in infarct center area [(0.22±0.19) mL/(min·g),(0.27±0.13) mL/g], and the detection values of mean transit time and local perfusion peak time [(12.7±3.1) s,(22.1±4.0) s] were lower than those in infarct center area [(18.8±3.9) s,(24.4±3.7) s], with statistical difference significance(t=10.152, 16.335, 7.744, 2.670, all P<0.05). The radiation dose of low dose group [(1.50±0.27) mSv] was significantly lower than that of conventional dose group [(3.48±0.61) mSv], with the significant difference(t=18.772, P<0.001). Conclusion The perfusion CT is helpful to evaluate the prognosis of patients in the recovery period of ischemic stroke, and it can accurately evaluate the improvement degree of local blood flow perfusion in the ischemic area, and low dose perfusion CT can reduce the radiation dose, which has an important guiding significance for clinical diagnosis and treatment.