头颅CT血管造影联合能谱CT全脑灌注评估缺血性脑卒中患者脑血管狭窄程度的价值

Application of cranial CTA combined with spectral CT perfusion imaging in the diagnosis of ischemic stroke

目的 探究头颅CT血管造影(CTA)联合能谱CT全脑灌注成像(CTP)对缺血性脑卒中患者脑血管狭窄程度的评估价值分析。方法 以2019年9月至2021年12月87例缺血性脑卒中患者为研究对象,均给予数字减影血管造影(DSA)、CTA及CTP检查。比较患者颅脑梗死区、半暗带及健侧的CTP检查参数[脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)、达峰时间(TTP)],分析患者梗死区CTP参数与血管狭窄程度的相关性及与CTA联合检测对患者血管狭窄程度的评估价值。结果 经DSA检查结果显示,87例缺血性脑卒中患者中存在轻度狭窄19例、中度狭窄50例、重度狭窄12例、闭塞6例;缺血性脑卒中患者梗死区、半暗带及健侧的CTP等指标比较差异有统计学意义(P<0.05);梗死区的CBF、CBV小于半暗带、健侧(P<0.05),MTT、TTP长于半暗带、健侧(P<0.05);半暗带的CBF、CBV小于健侧,MTT、TTP长于健侧(P<0.05);重度及闭塞组的CBF、CBV小于轻中度组,MTT、TTP长于轻中度组(P<0.05);缺血性脑卒中患者梗死区CBF与血管狭窄程度呈负相关,MTT、TTP与血管狭窄程度呈正相关(P<0.05);CTA联合CTP评估缺血性脑卒中患者血管狭窄程度的曲线下面积(AUC)大于各指标单独检测(P<0.05)。结论 头颅CTA联合CTP对缺血性脑卒中血管狭窄程度具有评估价值,且患者CTP检查参数与血管狭窄程度相关。

Objective To explore the application value of cranial CT angiography(CTA) combined with spectral CT perfusion imaging(CTP) in the diagnosis of ischemic stroke. Methods A total of 87 patients with ischemic stroke were enrolled as the research objects between September 2019 and December 2021. All patients underwent digital subtraction angiography(DSA), CTA and CTP. The diagnostic accuracy rate of CTA for the severity of vascular stenosis was analyzed. CTP parameters [cerebral blood volume(CBV), cerebral blood flow(CBF), mean transit time(MTT), time to peak(TTP)] of craniocerebral infarction area, penumbra and healthy side were analyzed.The correlation between CTP parameters in infarction area and the severity of vascular stenosis, and the evaluation value of CTP combined with CTA for severity degree of vascular stenosis were analyzed. Results DSA showed that among the 87 patients with ischemic stroke, there were 19 cases with mild stenosis, 50 cases with moderate stenosis,12 cases with severe stenosis and 6 cases with occlusion. Taking DSA results as the golden standard, diagnostic accuracy rate of CTA for the severity of vascular stenosis was 85.1%(74/87). There were significant differences in CTP parameters of infarction area, penumbra and healthy side(P<0.05). CBF and CBV of infarction area were lower than those of penumbra and healthy side, while MTT and TTP were longer than those of penumbra and healthy side(P<0.05). CBF and CBV of penumbra were lower than those of healthy side, while MTT and TTP were longer than those of healthy side(P<0.05). The CBF and CBV of the severe and occlusion group were lower than those of the mild-tomoderate group, and the MTT and TTP of the severe and occlusion group were longer than those of the mild-tomoderate group(P<0.05). CBF of infarction area was negatively correlated with the severity of vascular stenosis, while MTT and TTP were positively correlated with it(P<0.05). AUC of CTA combined with CTP for assessing the severity of vascular stenosis was greater than that of single index(P<0.05). Conclusion Cranial CTA combined with CTP has evaluation value for the severity of vascular stenosis in ischemic stroke. CTP parameters are related to the severity of vascular stenosis.