多模态CT在急性缺血性脑卒中诊断中的临床价值

Clinical value of multimodal CT in the diagnosis of acute ischemic stroke

目的探讨多模态CT在急性缺血性脑卒中诊断中的临床价值。方法回顾性分析蚌埠市第一人民医院神经内科2018年1月至2019年6月经磁共振弥散加权像确诊为急性缺血性脑卒中患者63例,所有患者均行常规CT平扫,CT灌注成像(CTP)及CT血管成像(CTA)检查,分析三者对急性缺血性脑卒中的诊断价值。结果梗死核心区脑血流量(CBF)、脑血容量(CBV)值小于梗死镜像区,平均通过时间(MTT),达峰反应时间(TMax)值大于梗死镜像区,差异存在统计学意义(P<0.05);半暗带区CBF及CBV值稍低于半暗带镜像区,差异无统计学意义(P>0.05),而MTT及TMax值大于半暗带镜像区,且差异有统计学意义(P<0.05);梗死核心区CBF、CBV值小于半暗带区,MTT及TMax值大于半暗带区,差异有统计学意义(P<0.05)。CTP联合CTA检查发现灌注异常且责任血管狭窄53例,阳性率为84%(53/63),且灌注异常与责任血管狭窄程度之间差异有统计学意义(P<0.05)。结论多模态CT能够对急性缺血性脑卒中进行快速准确全面的评估,判断梗死核心区、半暗带区血流灌注状态及血管狭窄情况,为临床制定个体化治疗方案提供依据,具有较高的临床诊疗价值。

Objective To explore the clinical value of multimodal CT in the diagnosis of acute ischemic stroke.Methods Retrospective analysis of 63 patients with acute ischemic stroke diagnosed by magnetic resonance diffu-sionweighted imaging from January 2018 to June 2019,Department of Neurology,First People′s Hospital,Bengbu,all patients were examined by conventional CT plain scan,CT perfusion imaging(CTP)and CT angiography(CTA).The diagnostic value of the three methods in acute ischemic stroke was analyzed,and the difference was compared and analyzed.Results The cercbral blood flow(CBF),cercbral blood volume(CBV)value of the infarct core area was smaller than that of the infarct mirror area,and the mean transit time(MTT)and time to maximum(TMax)value was larger than that of the infarct mirror area.The difference was statistically significant(P<0.05).The CBF and CBV values of the penumbra region were lower than those of the mirror region of the penumbra region,and there was no significant difference(P>0.05),but the MTT and TMax values were higher than those in the mirror region of the penumbra,and the difference was statistically significant(P<0.05).The CBF、CBV value of infarct core area was smaller than that of penumbra area,and the MTT and TMax value was larger than that of penumbra area(P<0.05).CTP combined CTA examination found abnormal perfusion and responsible vessel stenosis in 53 cases,the positive rate was 84%(53/63),and there was a statistical difference between perfusion abnormality and the degree of responsible vessel stenosis(P<0.05).Conclusion Multimodal CT can evaluate acute ischemic stroke quickly,accurately and comprehensively,judge the blood perfusion state and vascular stenosis in the core area and penumbra area of infarction,and provide the basis for individualized treatment plan in clinic,and has high clinical diagnosis and treatment value.