256排Revolution CT灌注成像联合血管造影在急性脑梗死中的临床应用价值

Clinical Application Value of 256 Slice Revolution CT Perfusion Imaging Combined with Angiography in Acute Cerebral Infarction

目的 探讨256排Revolution CT灌注成像(CTP)联合头颈部CT血管造影(CTA)在急性脑梗死患者临床诊断中的应用价值。方法 选取我院2022年1月至2022年6月期间收治的85例疑似急性脑梗死患者作为研究对象,所有患者发病24小时内行常规头部CT平扫、CT灌注成像(CTP)和头颈部CT血管造影(CTA)。CTP可获得急性梗死区与对侧镜像区脑组织的血流灌注参数,如脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)及达峰时间(TTP)等,并能判断有无缺血半暗带及其范围,提示临床尽早进行溶栓治疗,以挽救存活脑组织。头颈CTA可评估患者头颈部动脉有无狭窄、狭窄部位、狭窄程度及侧支循环形成情况。结果 85例患者中CTP有61例显示灌注异常,核心梗死区与缺血半暗带区灌注参数CBF、MTT、TTP相对于镜像区对比结果差异具有统计学意义(P <0.05),CBV相对于镜像区对比结果差异不具有统计学意义(P> 0.05),核心梗死区CBV、CBF低于缺血半暗带区(P <0.05),而MTT、TTP高于缺血半暗带区(P <0.05)。85例患者中CTA结果显示57例急性脑梗死患者存在不同程度的脑血管狭窄或闭塞,并与CTP异常灌注区相吻合,提示为责任血管。结论 在急性脑梗死的诊疗过程中,256排Revolution CT灌注成像联合头颈部CT血管造影检查可以评估局部脑组织血流灌注情况,有效区分核心梗死区与缺血半暗带区,明确缺血半暗带范围及相应的责任血管,评估侧支循环情况,对急性脑梗死的早期诊断及治疗方案的确定提供可靠依据。

Objective To investigate the clinical value of 256 row Revolution CT perfusion imaging(CTP) combined with head and neck CT angiography(CTA) in the diagnosis of acute cerebral infarction.Methods Eighty-five patients with suspected acute cerebral infarction admitted in our hospital from January 2022 to June 2022 were selected as the study objects.All patients were performed routine head CT plain scan,CT perfusion imaging(CTP) and head neck CT angiography(CTA) within 24 hours of onset.CTP can obtain the blood flow perfusion parameters of the brain tissue in the acute infarction area and the contralateral mirror area,such as cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT) and time to peak(TTP),and can judge whether there is ischemic penumbra and its range,suggesting that thrombolytic therapy should be carried out as early as possible to save the surviving brain tissue.Head and neck CTA can evaluate whether there is stenosis in the head and neck arteries,the location of stenosis,the degree of stenosis and the formation of collateral circulation.Results Sixty-one of the 85 patients showed abnormal perfusion in CTP,and the perfusion parameters CBF,MTT,TTP in the core infarct area and ischemic penumbra area were significantly different from those in the mirror image area(P0.05),CBV and CBF in the core infarction area were lower than those in the ischemic penumbra area(P<0.05),while MTT and TTP were higher than those in the ischemic penumbra area(P<0.05).CTA results of 85 patients showed that 57 patients with acute cerebral infarction had different degrees of cerebral vascular stenosis or occlusion,which coincided with the abnormal perfusion area of CTP,suggesting that they were responsible vessels.Conclusion During the diagnosis and treatment of acute cerebral infarction,256 row Revolution CT perfusion imaging combined with head and neck CT angiography can evaluate the regional cerebral blood flow perfusion,effectively distinguish the core infarction area and ischemic penumbra area,determine the scope of ischemic penumbra and the corresponding responsible vessels,and evaluate the collateral circulation.It provides reliable basis for early diagnosis and treatment of acute cerebral infarction.