多层螺旋CT脑灌注成像与平扫CT值差值测量对急性脑梗死的诊断价值分析

Analysis of the diagnostic value of the difference between multi-slice spiral CT cerebral perfusion imaging and plain CT in the diagnosis of acute cerebral infarction

目的分析多层螺旋CT脑灌注成像与平面CT值差值测量对急性脑梗死的诊断价值。方法240例临床拟诊为急性脑梗死的患者,均进行多层螺旋CT脑灌注成像和头部CT平扫。分析CT平扫结果和CT灌注成像结果,评估脑CT灌注成像达峰时间(TTP)、脑血流量(CBF)和脑血容量(CBV),测量两侧对称部位的CT值差值;比较患者患侧和对侧病灶中心CBF、CBV、TTP,病灶中心和周边及对侧相对脑血流量(rCBF)、相对脑血容量(rCBV)、相对达峰时间(rTTP)。结果240例急性脑梗死患者经过CT平扫,肉眼观察发现可疑病灶141例,平均CT值差值为(4.21±1.65)Hu;其中35例可疑病灶的CT值差值>2.80 Hu。在3~7 d内复查CT,经过临床随访等证实为短暂性脑缺血发作2例,急性脑梗死患者238例。经多层螺旋CT脑灌注成像显示,238例患者的脑CT灌注成像灌注异常,2例灌注正常;238例CT脑灌注成像异常患者患侧病灶中心CBF(10.34±4.91)ml/(min·100 g)、CBV(33.28±17.12)ml/kg低于对侧病灶中心的(39.44±3.16)ml/(min·100 g)、(48.65±3.72)ml/kg,TTP(16.01±2.49)s长于对侧病灶中心的(9.08±0.75)s,差异有统计学意义(P<0.05)。病灶中心rCBF(10.34±4.91)ml/(min·100 g)、rCBV(33.28±17.12)ml/kg和周边rCBF(20.93±5.24)ml/(min·100 g)、rCBV(37.89±11.64)ml/kg低于对侧的(39.44±3.16)ml/(min·100 g)、(48.65±3.72)ml/kg,rTTP(16.01±2.49)s和(14.39±1.71)s长于对侧的(9.08±0.75)s,差异有统计学意义(P<0.05);病灶中心rCBF、rCBV低于病灶周边,rTTP长于病灶周边,差异有统计学意义(P<0.05)。结论多层螺旋CT脑灌注成像和平扫CT值差值测量可以实现对急性脑梗死患者的早期诊断,有助于了解患者的中心梗死区和缺血半暗带区域,可对临床的诊断和治疗工作提供科学的参考。

Objective To analyze the diagnostic value of the difference between multi-slice spiral CT cerebral perfusion imaging and plain CT in the diagnosis of acute cerebral infarction.Methods There were 240 patients with suspected acute cerebral infarction,and all received multi-slice spiral CT cerebral perfusion imaging and plain CT.CT scan results and CT perfusion imaging results were analyzed to assess the time to peak(TTP),cerebral blood flow(CBF)and cerebral blood volume(CBV)of cerebral CT perfusion imaging.The difference in CT value of bilateral symmetrical parts was measured.Comparison was made on CBF,CBV,and TTP between the affected and contralateral lesion centers of patients,as well as the relative cerebral blood flow(rCBF),relative cerebral blood volume(rCBV),and relative time to peak(rTTP)in the center of the lesion,the periphery of the lesion,and the contralateral side.Results Among the 240 patients with acute cerebral infarction,141 cases were found to have suspicious lesions after plain CT scan,with a mean CT value difference of(4.21±1.65)Hu;among them,35 suspicious lesions had a CT value difference>2.80 Hu.The CT was reexamined within 3-7 d and confirmed to be transient ischemic attack in 2 cases and acute cerebral infarction in 238 patients after clinical follow-up,etc.The cerebral perfusion imaging of multi-slice spiral CT showed that the perfusion of 238 patients was abnormal,and the perfusion was normal in 2 cases.In 238 patients with abnormal CT cerebral perfusion imaging,the CBF(10.34±4.91)ml/(min·100 g)and CBV(33.28±17.12)ml/kg in the affected lesion center were lower than(39.44±3.16)ml/(min·100 g)and(48.65±3.72)ml/kg in the contralateral lesion center;the TTP(16.01±2.49)s in the affected lesion center was longer than(9.08±0.75)s in the contralateral lesion center;the differences were all statistically significant(P<0.05).The rCBF and rCBV of the center of the lesion were(10.34±4.91)ml/(min·100 g)and rCBV(33.28±17.12)ml/kg,and thoes of the periphery of the lesion were(20.93±5.24)ml/(min·100 g)and(37.89±11.64)ml/kg,which were lower than(39.44±3.16)ml/(min·100 g)and(48.65±3.72)ml/kg of the contralateral side;the rTTP in the center and periphery of the lesion were(16.01±2.49)and(14.39±1.71)s,which were longer than(9.08±0.75)s of the contralateral of the lesion;the differences were all statistically significant(P<0.05).The rCBF and rCBV of the center of the lesion were lower than those of the periphery of the lesion,and the rTTP was longer than that of the periphery of the lesion,and the differences were statistically significant(P<0.05).Conclusion Early diagnosis of patients with acute cerebral infarction can be achieved by measuring the difference between multi-slice spiral CT cerebral perfusion imaging and plain CT value,which can help to understand the central infarct area and ischemic penumbra area of patients,and can provide scientific reference for clinical diagnosis and treatment work.