CT血管成像(CTA)联合CT灌注成像(CTP)在前循环缺血性脑梗死诊断中的临床价值研究

Clinical value of CT angiography(CTA)combined with CT perfusion imaging(CTP)in the diagnosis of anterior circulation ischemic cerebral infarction

目的分析CT血管成像(CTA)联合CT灌注成像(CTP)在前循环缺血性脑梗死诊断中的临床价值。方法选取无锡市锡山人民医院影像科2018年8月-2022年5月接诊的126例缺血性脑梗死患者为研究对象,分别给予CTA、CTP检查,将全脑数字减影血管造影(DSA)作为此次研究金标准,比较CTA、CTP、CTA联合CTP诊断前循环缺血性脑梗死准确率、灵敏度、特异度,Kappa检验CTA、CTP、CTA联合CTP与DSA的一致性。比较梗死区、半暗带区、对照脑区CTP参数,分析大脑前动脉、大脑中动脉、眼动脉、脉络膜前动脉CTA成像狭窄程度。结果CTA联合CTP诊断准确率(95.24%)、灵敏度(95.12%)、特异度(95.45%)均高于CTA(77.78%、82.93%、68.18%)、CTP(80.95%、85.37%、72.73%),P<0.05,Kappa检验CTA、CTP与DSA一致性均一般(Kappa值=0.568、0.581),CTA联合CTP与DSA一致性较好(Kappa值=0.796),P<0.05。梗死区最大达峰时间(TTP)、平均通过时间(MTT)均高于半暗带区、对照脑区,P<0.05,梗死区脑血流量(CBF)、脑血容量(CBV)均低于半暗带区、对照脑区,P<0.05。82例DSA确诊的前循环缺血性脑梗死患者共发现93处狭窄动脉,闭塞占8.60%、重度占21.51%、中度占43.01%、轻度占26.88%。结论CTA联合CTP在前循环缺血性脑梗死诊断中具有较高的准确率、灵敏度、特异度,CTP可提供CBF、CBV等参数,CTA可明确前循环动脉狭窄程度,两者相结合可弥补单一诊断的不足,具有一定的临床价值。

Objective To analyze the clinical value of CT angiography(CTA)combined with CT perfusion imaging(CTP)in the diagnosis of anterior circulation ischemic cerebral infarction.Methods A total of 126 patients with ischemic cerebral infarction admitted to the imaging department of Xishan People's Hospital in Wuxi City from August 2018 to May 2022 were selected.As the gold standard of this study,the accuracy,sensitivity and specificity of CTA,CTP,CTA combined with CTP in the diagnosis of anterior circulation ischemic cerebral infarction were compared,and the consistency of CTA,CTP,CTA combined with CTP and DSA was tested by Kappa.The CTP parameters of infarcted area,penumbra area and control brain area were compared,and the degree of stenosis of anterior cerebral artery,middle cerebral artery,ophthalmic artery and anterior choroidal artery was analyzed.Results The diagnostic accuracy(95.24%),sensitivity(95.12%),and specificity(95.45%)of CTA combined with CTP were higher than those of CTA(77.78%,82.93%,68.18%),CTP(80.95%,85.37%,72.73%)),P<0.05,Kappa test CTA,CTP and DSA were all in good agreement(Kappa value=0.568,0.581),CTA combined with CTP and DSA had better agreement(Kappa value=0.796),P<0.05.The maximum time to peak(TTP)and mean transit time(MTT)in the infarcted area were higher than those in the penumbra area and the control brain area,P<0.05,and the cerebral blood flow(CBF)and cerebral blood volume(CBV)in the infarcted area were lower than Penumbra area and control brain area,P<0.05.A total of 93 stenotic arteries were found in 82 patients with anterior circulation ischemic cerebral infarction confirmed by DSA,with occlusion accounting for 8.60%,severe accounting for 21.51%,moderate accounting for 43.01%,mild degree accounted for 26.88%.Conclusion CTA combined with CTP has high accuracy,sensitivity and specificity in the diagnosis of anterior circulation ischemic cerebral infarction.CTP can provide parameters such as CBF and CBV,and CTA can determine the degree of anterior circulation arterial stenosis.It has certain clinical value to make up for the deficiency of a single diagnosis.