CT灌注扫描技术在急性缺血性脑卒中中的临床应用

Clinical application of CT perfusion in acute ischemic stroke

目的探讨CT灌注扫描(CTP)技术在急性缺血性脑卒中中的临床应用。方法选取80例临床诊断高度怀疑急性缺血性脑卒中患者作为研究对象,患者均接受CT平扫、CTP技术、CT血管造影(CTA)检查。观察脑部CT平扫、CTP检查结果,比较CTP图像显示治疗前后患者对侧区、梗死区及缺血半暗带区参数。结果80例高度怀疑急性缺血性脑卒中患者经脑部CT平扫后,共检出38例早期低密度病灶,42例无明显异常。80例患者CTP检查发现,8例无缺血半暗带,无明显异常,随访1年后确诊为短暂性脑缺血发作(TIA);72例脑灌注有异常状况,经图像工作站配套软件分析后发现,39例有红色梗死区和黄色缺血半暗带区,33例仅小部分黄色异染区或无典型黄色缺血半暗带,随访1年后确诊为急性缺血性脑卒中。39例患者接受CTP检查图像有梗死区及缺血半暗带区,进一步分析其参数指标显示,其梗死区平均通过时间(MTT)(9.51±0.21)s长于对侧区的(4.51±0.65)s,脑血容量(CBV)(1.68±0.31)ml/100 g、脑血流量(CBF)(5.31±0.42)ml/(100 g·min)低于对侧区的(3.12±0.23)ml/100 g、(51.35±1.32)ml/(100 g·min),差异有统计学意义(P<0.05);缺血半暗带区MTT(7.61±0.51)s长于对侧区(4.51±0.65)s,CBF(31.21±1.36)ml/(100 g·min)低于对侧区的(51.35±1.32)ml/(100 g·min),差异有统计学意义(P<0.05);但缺血半暗带区和对侧区的CBV比较差异无统计学意义(P>0.05);梗死区MTT(9.51±0.21)s长于缺血半暗带区的(7.61±0.51)s,CBV(1.68±0.31)ml/100 g、CBF(5.31±0.42)ml/(100 g·min)低于缺血半暗带区的(3.11±0.21)ml/100 g、(31.21±1.36)ml/(100 g·min),差异有统计学意义(P<0.05)。CTP检查图像显示,治疗后梗死区MTT、CBV、CBF分别为(4.31±1.01)s、(3.18±0.45)ml/100 g、(50.32±1.21)ml/(100 g·min),缺血半暗带区分别为(4.61±1.02)s、(3.15±0.37)ml/100 g、(50.65±1.37)ml/(100 g·min),对侧区分别为(4.51±0.65)s、(3.12±0.23)ml/100 g、(51.35±1.32)ml/(100 g·min)。缺血半暗带区、梗死区与对侧区MTT、CBV、CBF比较,差异无统计学意义(P>0.05)。治疗后梗死区MTT短于本区治疗前,CBV、CBF高于本区治疗前,差异有统计学意义(P<0.05);缺血半暗带区MTT短于本区治疗前,CBF高于本区治疗前,差异有统计学意义(P<0.05)。结论临床可采用CTP技术检查高度怀疑急性缺血性脑卒中患者,通过评估患者颅内CTA、侧支循环状况、脑血流灌注成像状况,为临床诊治急性缺血性脑卒中提供更为客观、全面的信息依据,确保治疗效果。

Objective To discuss the clinical application of CT perfusion(CTP)in acute ischemic stroke.Methods 80 patients with a high clinical diagnosis of acute ischemic stroke were selected for the study,and all patients underwent CT plain scan,CTP,and CT angiography(CTA).The results of CT plain and CTP examinations of the brain were observed,and the parameters of the contralateral area,infarct area and ischemic semidark zone area of the patients before and after CTP image display treatment were compared.Results In 80 patients with highly suspected acute ischemic stroke,early hypointense lesions were detected in 38 cases and no significant abnormalities in 42 cases after CT plain scan of the brain.8 cases underwent CTP examination,and 8 cases were found to have no ischemic semidark zones and no significant abnormalities,and the patients were diagnosed with transient ischemic attack(TIA)after 1-year follow-up.72 cases had abnormal cerebral perfusion,and after analysis by the image workstation software,39 cases had red infarct areas and yellow ischemic semidark zones,and 33 cases had only small yellow heterochromatic areas or no typical yellow ischemic semidark zones,and the patients were diagnosed with acute ischemic stroke after follow-up.39 patients underwent CTP examination images with infarct areas and ischemic semidark zone areas,and further analysis of their parametric indicators showed that their mean transit time(MTT)in the infarct area(9.51±0.21)s was longer than(4.51±0.65)s in the contralateral area,and cerebral blood volume(CBV)(1.68±0.31)ml/100 g,cerebral blood flow(CBF)(5.31±0.42)ml/(100 g·min)were lower than(3.12±0.23)ml/100 g and(51.35±1.32)ml/(100 g·min)in the contralateral area,and the differences were statistically significant(P<0.05).The MTT(7.61±0.51)s in the ischemic semidark zone was higher than(4.51±0.65)s in the contralateral zone,and the CBF(31.21±1.36)ml/(100 g·min)was longer than(51.35±1.32)ml/(100 g·min)in the contralateral zone,and the differences were statistically significant(P<0.05),but there was no statistically significant difference in CBV of ischemic semidark zone area and contralateral area(P>0.05).The MTT(9.51±0.21)s in the infarct area was longer than(7.61±0.51)s in the ischemic semidark zone;the CBV and CBF in the infarct area were(1.68±0.31)ml/100 g and(5.31±0.42)ml/(100 g·min),which were lower than(3.11±0.21)ml/100 g and(31.21±1.36)ml/(100 g·min)in the ischemic semidark zone;the differences were statistically significant(P<0.05).CTP examination images showed that MTT,CBV,CBF were(4.31±1.01)s,(3.18±0.45)ml/100 g,(50.32±1.21)ml/(100 g·min)in the infarct zone,(4.61±1.02)s,(3.15±0.37)ml/100 g,(50.65±1.37)ml/(100 g·min)in the ischemic semidark zone,and(4.51±0.65)s,(3.12±0.23)ml/100 g,(51.35±1.32)ml/(100 g·min)in the contralateral area.There was no statistically significant difference in MTT,CBV and CBF among ischemic semidark zone,infarcted area and contralateral area(P>0.05).After treatment,the MTT in the infarcted area was shorter than that before treatment,and CBV and CBF were higher than that before treatment,and the differences were statistically significant(P<0.05).The MTT in ischemic semidark zone was shorter than that before treatment,and CBF was higher than that before treatment,the differences were statistically significant(P<0.05).Conclusion CTP can be used clinically to examine patients with high suspicion of acute ischemic stroke,and provide more objective and comprehensive information basis for clinical diagnosis and treatment of acute ischemic stroke by assessing patients'intracranial CTA,lateral branch circulation status,and cerebral perfusion imaging status to ensure therapeutic effect.