计算机断层扫描灌注成像在老年急性缺血性脑卒中诊断及静脉溶栓治疗中的应用

Application of computed tomography perfusion imaging in diagnosis and intravenous thrombolysis of acute ischemic stroke in elderly patients

目的探讨计算机断层扫描灌注成像(CTP)在老年急性缺血性脑卒中(AIS)诊断及静脉溶栓治疗中的应用价值。方法收集2020年3月至2022年3月于邯郸市中心医院行静脉溶栓治疗的88例老年AIS患者的临床资料,所有患者入院后进行计算机断层扫描(CT)平扫、CTP检查,并于溶栓后7 d行相同参数复查,测量溶栓前后核心梗死区、缺血半暗带及健侧相应区域的脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)等灌注参数变化,并评估美国国立卫生院卒中量表(NIHSS)评分变化,采用Pearson相关分析各灌注参数差值与NIHSS评分差值的关系。结果88例老年AIS患者中,CT平扫共检出50例患者存在低密度灶和早期脑缺血征象,诊断灵敏度为56.82%;CTP检查共检出76例患者存在异常灌注区域,诊断灵敏度为86.36%。两种检查方式诊断灵敏度比较,差异有统计学意义(P﹤0.05)。溶栓前,核心梗死区、缺血半暗带区的CBF、CBV值均低于健侧相应区域,且核心梗死区低于缺血半暗带区,而MTT、TTP值均高于健侧相应区域,且核心梗死区高于缺血半暗带区(P﹤0.05)。溶栓7 d后,核心梗死区的CBF、CBV值略高于溶栓前,MTT、TTP值略低于溶栓前,但差异均无统计学意义(P﹥0.05);缺血半暗带区的CBF、CBV值明显高于溶栓前,MTT、TTP值明显低于溶栓前(P﹤0.05);健侧相应区域的CBF、CBV、MTT、TTP值均无明显变化(P﹥0.05)。溶栓7 d后,老年AIS患者NIHSS评分低于溶栓前,差异有统计学意义(P﹤0.05)。Pearson相关分析显示,△CBF、△CBV与△NIHSS评分均呈显著负相关(r=-0.426、-0.388,P﹤0.01),而△MTT、△TTP与△NIHSS评分均呈显著正相关(r=0.406、0.394,P﹤0.01)。结论CTP对老年AIS诊断具有重要意义,可通过分析是否存在缺血半暗带指导老年AIS患者静脉溶栓治疗。

Objective To investigate the application value of computed tomography perfusion imaging(CTP)in the diagnosis and intravenous thrombolysis of acute ischemic stroke(AIS)in elderly patients.Method The clinical data of 88 elderly AIS patients receiving intravenous thrombolytic therapy in Handan Central Hospital from March 2020 to March 2022 were collected.Computer tomography(CT)and CTP examinations were performed for all patients after admission,and the same parameters were re-examined 7 days after thrombolysis.Cerebral blood flow(CBF),cerebral blood volume(CBV),mean time to transit(MTT),time to peak(TTP)and other perfusion parameters were measured before and after thrombolysis,and the National Institutes of Health Stroke Scale(NIHSS)score was evaluated.The relationship between the difference of perfusion parameters and the difference of NIHSS score was analyzed by Pearson correlation.Result Among 88 elderly AIS patients,50 patients with low density foci and early cerebral ischemia were detected by plain CT scan,and the diagnostic sensitivity was 56.82%.A total of 76 patients with abnormal perfusion areas were detected by CTP examination,and the diagnostic sensitivity was 86.36%.The difference in diagnostic sensitivity between the two methods was statistically significant(P<0.05).Before thrombolysis,CBF and CBV values in the core infarction area and ischemic penumbra area were lower than those in the healthy side,and the core infarction area was lower than that in the ischemic penumbra area,while MTT and TTP values were higher than those in the healthy side,and the core infarction area was higher than that in the ischemic penumbra area(P<0.05).After 7 days of thrombolysis,the CBF and CBV values in the core infarction area were slightly higher than before thrombolysis,and the MTT and TTP values were slightly lower than before thrombolysis,but the differences were not statistically significant(P>0.05).The values of CBF and CBV in ischemic penumbra were significantly higher than those before thrombolysis,the values of MTT and TTP were significantly lower than those before thrombolysis(P<0.05).There were no significant changes in CBF,CBV,MTT and TTP values in the corresponding areas of healthy side(P>0.05).After 7 days of thrombolysis,the NIHSS score of elderly AIS patients was significantly lower than that before thrombolysis,with statistical significance(P<0.05).Pearson correlation analysis showed that△CBF,△CBV were significantly negatively correlated with△NIHSS scores(r=-0.426,-0.388,P<0.01),while△MTT,△TTP were significantly positively correlated with△NIHSS scores(r=0.406,0.394,P<0.01).Conclusion CTP is of great significance to the diagnosis of elderly AIS,and can be used to guide intravenous thrombolysis in elderly AIS patients by analyzing whether there is an ischemic penumbra.