CT灌注成像在超早期缺血性脑血管病的应用研究

Application of CT perfusion imaging in hyperacute ischemic cerebrovascular disease

目的 探讨CT灌注成像 (CTPI)在超早期缺血性脑血管病中的应用价值。方法 对4 6例缺血性脑血管病患者在发病后 6h内先行普通头颅CT平扫 ,再进行CTPI检查。结果 普通CT平扫显示 :4 6例缺血性脑血管病患者在发病后 6h内 ,显示低密度灶者 5例 ,诊断为脑梗死。未见异常者 4 1例 ,经临床追踪和复查CT证实 ,12例为短暂性脑缺血发作 (TIA) ,2 9例为脑梗死。 4 6例缺血性脑血管病发作 6h内的患者在CTPI显示 :①灌注正常者 16例 ,其中 12例临床诊断为TIA ,4例小体积脑梗死。②灌注异常者 30例 ,其中 2 5例普通CT未显示病灶 ,5例在CTPI显示的病灶范围较普通CT显示的病灶范围增大。CTPI异常的 30例患者rCBF、TP、MTT改变明显 ,病灶侧与健侧、病灶中心区与周边区比较 ,差异有显著意义 (P <0 .0 5 )。结论 CTPI能够超早期诊断脑梗死 ,并可鉴别诊断TIA。通过分析病灶内的血流灌注状态 ,明确病灶的部位、大小及范围 ,显示了半暗带的存在 ,对于超早期缺血性脑血管病患者选择治疗方案和判断预后具有重要意义。

Objective To investigate the application of computed tomography perfusion imaging(CTPI)in hyperacute ischemic cerebrovascular disease. Methods Conventional computed tomography (CT) and CTPI were performed within 6 hours of symptom onset in 46 patients with cerebrovascular disease. Results In 46 cases,5 cases diagnosed as cerebral infarction obtained regular CT positive results.In 41 having regular CT negative results,29 had cerebral infarction,and the other 12 had transient ischemic attack(TIA).In 16 cases with CTPI negtive,12 were diagnosed as having TIA and the others having small infarction volume.30 cases were confirmed by CTPI as having ischemic lesions.In 30 cases,5 had ischemic lesions larger in CTPI than in regular CT and 25 had regular CT negtive results.The regional cerebral blood flow(rCBF),time to peak(TP),mean transit time(MTT)in 30 cases with CTPI positive were found obviously changed.The side of ischemic lesion as compared with the opposite side,and the core of ischemic lesion as compared with peripheral zone were found changed significantly( P <0.05). Conclusions CTPI can be used to diagnose hyperacute cerebral infarction and to distinguish TIA.By analysis on blood perfusion statue,CTPI is possibly used to determine the position,area and the range of the ischemic lesion and penumbra.It should be meaningful for evaluating prognosis and giving treatment to the patients with hyperacute ischemic cerebrovascular disease.