Perihematomal Perfusion Typing and Spot Sign of Acute Intracerebral Hemorrhage with Multimode Computed Tomography: A Preliminary Study

Objective To explore the perihematomal perfusion typing and spot sign on computed tomography angiography(CTA) source images in order to assist in individualizing therapeutic decisions for patients with intracerebral hemorrhage by possibly forecasting perihematomal ischemia and hematoma enlargement. Methods We examined 58 patients with spontaneous intracerebral hemorrhage by computed tomography perfusion and CTA within 6 hours after symptom onset. Hematoma volumes were determined from non-contrast CT images and compared between first and second CT images. The perfusion of hematoma region and perihematoma region was evaluated for presence or absence of the perihematomal penumbra. Three kinds of perihematoma perfusion typing were defined according to the perfusion of hematoma region and perihematoma region. CTA source images was reviewed to make sure presence or absence of the spot sign. Results Finally, 53 patients(34 males, 19 females) were enrolled in our study according to exclusion criteria. Finally, 21 patients were classified into the normal group, 23 patients were classified into the mild group, and 9 patients were classified into the severe group. There were significant differences in hematoma size between the presence and absence of the perihematomal penumbra group(P<0.05). Thirteen(24.5%) patients presented with spot sign. Hematoma expansion occurred in 15(28.3%) patients on follow-up. In which 12 patients were with spot sign. Sensitivity, specificity, positive predictive value, and negative predictive value for expansion were 80.0%, 97.4%, 92.3%, and 92.5%, respectively. Conclusion In acute intracerebral hemorrhage patients, the perihematoma perfusion typing and CTA spot sign provide more radiological information that might assist in individualizing therapeutic decisions for patients by possibly forecasting perihematomal ischemia and hematoma enlargement.

A correlation of computed tomography perfusion and histopathology in tumor edges of hepatocellular carcinoma

BACKGROUND： The peripheral morphologic characteristics of hepatocellular carcinoma （HCC） reflect tumor growth patterns. Computed tomography （CT） perfusion is a new method to analyze hemodynamic changes in tissues. We assessed the relationship between CT perfusion and histopathologic findings in the periphery of HCC lesions. METHODS： Non-contrast CT, enhanced dual-phase CT, and CT perfusion were performed on 77 subjects （47 patients and 30 controls）. Based on the imaging findings of enhanced dual- phase CT, the tumor edges were classified into three types： type Ⅰ （sharp）; type Ⅱ （blurry）; and type Ⅲ （mixed）. The CT perfusion parameters included hepatic blood flow, hepatic arterial fraction, hepatic arterial perfusion, and hepatic portal perfusion. The tissue sections from resected specimens were subjected to routine hematoxylin and eosin staining and immunohistochemical staining for CD34. The correlations between microvessel density （MVD） and the CT perfusion parameters were analyzed using Pearson＇s product-moment correlation coefficient. Changes in the perfusion parameters in tumor edges of different tumor types were evaluated. RESULTS： Type Ⅰ （sharp）： the pathologic findings showed fibrous connective tissue capsules in the tumor edges, and an MVD 〈30/ram2. Type Ⅱ （blurry）： the histology showed that the edges were clear with no capsules and an MVD 〉30/ram2. Type Ⅲ （mixed）： the pathology was similar to that of types I and II, and an MVD 〉30/mm~. Hepatic blood flow, hepatic arterial fraction, hepatic arterial perfusion, and hepatic portal perfusion were significantly increased in the tumor edges of HCC patients compared to those of the controls （P〈0.05）. The correlation between CT perfusion parameters and MVD was higher in blurry tumor edges of type II than in those of types Ⅰ or Ⅲ. CONCLUSION： CT perfusion imaging of tumor edges may be helpful in revealing histopathological features, and indirectly reflect angiogenic changes of HCCs.

Role of pulmonary perfusion magnetic resonance imaging for the diagnosis of pulmonary hypertension:A review

Among five types of pulmonary hypertension,chronic thromboembolic pulmonary hypertension(CTEPH)is the only curable form,but prompt and accurate diagnosis can be challenging.Computed tomography and nuclear medicine-based techniques are standard imaging modalities to non-invasively diagnose CTEPH,however these are limited by radiation exposure,subjective qualitative bias,and lack of cardiac functional assessment.This review aims to assess the methodology,diagnostic accuracy of pulmonary perfusion imaging in the current literature and discuss its advantages,limitations and future research scope.

0D-1D coupling model and 3D fluid-structure interaction model based on coronary CT angiography for displaying hemodynamic characteristics of coronary artery stenosis

Objective To observe value of 0D-1D coupling model and 3D fluid-structure interaction(FSI)model based on coronary CT angiography(CCTA)for displaying hemodynamic characteristics of coronary artery stenosis.Methods Based on CCTA data of the stenosed left anterior descending branch(LAD)in a patient with coronary heart disease,an 0D-1D coupling model and 3D FSI model were built,respectively.Then hemodynamic characteristic indexes,including the pressure,flow velocity and wall shear stress(WSS)were obtained in every 0.01 s during 1 s at 5 sampling points(i.e.sampling point 1—5)using these 2 models,respectively,and the consistencies of the results between models were evaluated with Spearman correlation coefficient r s.Results The time consuming for construction of 0D-1D coupling model and 3D FSI model was 0.033 min and 704 min,respectively.Both models showed basically distribution of the pressure,flow velocity and WSS of the stenosed LAD.For more details,the pressure at the stenosed segment of LAD and the proximal segment of stenosis were both higher,which gradually decreased at the distal segment of stenosis,and the flow velocity at the proximal segment of stenosis was in a relatively slow and uniform condition,with significantly increased flow velocity and WSS at the stenosed segment.Compared with 3D FSI model,0D-1D vascular coupling model was relatively unrefined and lack of distal flow lines when displaying blood flow velocity.For sampling point 2 at the stenosed segment of LAD,no significant consistency for pressure between 2 models was found(P=0.118),but strong consistency for the flow velocity and WSS(r s=0.730,0.807,both P<0.05).The consistencies of pressure,flow velocity and WSS between 2 models at the proximal and distal segment of stenosis,i.e.1,3—5 sampling points were week to moderate(r s=0.237—0.669,all P<0.05).Conclusion 0D-1D coupling model exhibited outstanding computational efficiency and might provide relatively reasonable results,while 3D FSI model showed higher accuracy for details and streamline when simulating LAD stenosis.

Novel Approaches for the Use of Cardiac/Coronary Computed Tomography Angiography

Recent developments in the novel imaging technology of cardiac computed tomography(CT)not only permit detailed assessment of cardiac anatomy but also provide insight into cardiovascular physiology.Foremost,coronary CT angiography(CCTA)enables direct noninvasive examination of both coronary artery stenoses and atherosclerotic plaque characteristics.Calculation of computational fl uid dynamics by cardiac CT allows the noninvasive estimation of fractional fl ow reserve,which increases the diagnostic accuracy for detection of hemodynamically signifi cant coronary artery disease.In addition,a combination of myocardial CT perfusion and CCTA can provide simultaneous anatomical and functional assessment of coronary artery disease.Finally,detailed anatomical evaluation of atrial,ventricular,and valvular anatomy provides diagnostic information and guidance for procedural planning,such as for transcatheter aortic valve replacement.The clinical applications of cardiac CT will be extended with the development of these novel modalities.

Perfusion CT findings in liver of patients with tumor during chemotherapy

AIM: To investigate the microcirculation changes in liver of patients with tumor during chemotherapy by perfusion computed tomography (CT). METHODS: Sixty patients with tumor and 20 controls were enrolled in this study. Perfusion CT parameters of patients and controls were compared, including hepatic perfusion index (HPI), mean transit time (MTT), and permeability-surface area product (PS). Correlation between perfusion CT parameters, treatment cycle and alanine aminotransferase (ALT) level was studied. RESULTS: No difference was found in HPI (25.68% ± 7.38% vs 26.82% ± 5.13%), MTT (19.67 ± 5.68 s vs21.70 ± 5.43 s) and PS (17.00 ± 4.56 mL/100 mL per min vs 19.92 ± 6.35 mL/100 mL per min) between pa- tients and controls. The HPI and MTT were significantly higher in patients undergoing 2 cycles of chemotherapy than in controls and those undergoing 1 cycle of che- motherapy (29.76% ± 5.87% vs 25.68% ± 7.38% and 25.35% ± 4.05%, and 25.61 ± 5.01 s vs 19.67 ± 5.68 s and 19.74 ± 4.54 s, respectively, P < 0.05). The HPI was higher in patients with hepatic steatosis than in controls and those without hepatic steatosis (30.85% ± 6.17% vs 25.68% ± 7.38% and 25.70% ± 4.24%, P < 0.05). Treatment cycle was well correlated with HPI and MTT (r = 0.40, r = 0.50, P < 0.01). ALT level was not correlated with perfusion CT parameters. CONCLUSION: HPI and MTT are significantly increased in patients with tumor during chemotherapy and well correlated with treatment cycle. Chemotherapy affects hepatic microcirculation in patients with tumor. Changes in hepatic microcirculation can be quantitatively assessed by perfusion CT.

Evaluation of the dual vascular supply patterns in ground-glass nodules with a dynamic volume computed tomography

BACKGROUND In recent years,the detection rate of ground-glass nodules(GGNs)has been improved dramatically due to the popularization of low-dose computed tomography(CT)screening with high-resolution CT technique.This presents challenges for the characterization and management of the GGNs,which depends on a thorough investigation and sufficient diagnostic knowledge of the GGNs.In most diagnostic studies of the GGNs,morphological manifestations are used to differentiate benignancy and malignancy.In contrast,few studies are dedicated to the assessment of the hemodynamics,i.e.,perfusion parameters of the GGNs.AIM To assess the dual vascular supply patterns of GGNs on different histopathology and opacities.METHODS Forty-seven GGNs from 47 patients were prospectively included and underwent the dynamic volume CT.Histopathologic diagnoses were obtained within two weeks after the CT examination.Blood flow from the bronchial artery[bronchial flow(BF)]and pulmonary artery[pulmonary flow(PF)]as well as the perfusion index(PI)=[PF/(PF+BF)]were obtained using first-pass dual-input CT perfusion analysis and compared respectively between different histopathology and lesion types(pure or mixed GGNs)and correlated with the attenuation values of the lesions using one-way ANOVA,student’s t test and Pearson correlation analysis.RESULTS Of the 47 GGNs(mean diameter,8.17 mm;range,5.3-12.7 mm),30(64%)were carcinoma,6(13%)were atypical adenomatous hyperplasia and 11(23%)were organizing pneumonia.All perfusion parameters(BF,PF and PI)demonstrated no significant difference among the three conditions(all P>0.05).The PFs were higher than the BFs in all the three conditions(all P<0.001).Of the 30 GGN carcinomas,14 showed mixed GGNs and 16 pure GGNs with a higher PI in the latter(P<0.01).Of the 17 benign GGNs,4 showed mixed GGNs and 13 pure GGNs with no significant difference of the PI between the GGN types(P=0.21).A negative correlation(r=-0.76,P<0.001)was demonstrated between the CT attenuation values and the PIs in the 30 GGN carcinomas.CONCLUSION The GGNs are perfused dominantly by the PF regardless of its histopathology while the weight of the BF in the GGN carcinomas increases gradually during the progress of its opacification.

CT Perfusion Imaging Predicts One-Month Outcome in Patients with Acute Spontaneous Hypertensive Intracerebral Hemorrhage

Purpose: Little is known about the relationship between perihematomal perfusion parameters in acute spontaneous hypertensive intracerebral hemorrhage patients and recent outcome. The purpose of this study was to evaluate the relationship between the perfusion parameters of the perihematomal brain tissue and the recent prognosis of patients with acute spontaneous hypertensive intracerebral hemorrhage (shICH) using CT perfusion (CTP) imaging. Methods: Twenty-six patients with clinical and CT diagnosed supratentorial shICH received CTP scanning within 8 - 19 h after symptom onset. At the maximum levels of the hematoma, cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) of perihematomal area (isodense within 1cm rim of perilesion area on plain CT) and contralateral mirrored hemisphere were measured, and rCBF, rCBV, rMTT were calculated (ipsilateral/contralateral). The one-month follow-up in accordance with daily living table (Barthel index, BI) by telephone was recorded. Results: The CBV, CBF, and MTT values of perihematoma area were (1.61 ± 1.53) ml·100 g-1, (16.48 ± 12.58) ml·100 g-1·min-1, and (9.12 ± 2.57) s, respectively. (For more information,please refer to the PDF)

Future of cardiac computed tomography

Coronary computed tomography angiography(CCTA)has become an integral tool in the noninvasive diagnostic workup of patients with suspected coronary artery disease in both elective and emergency settings. Today, it represents a mature technique providing accurate, non-invasive morphological assessment of the coronary arteries and atherosclerotic plaque burden. Iterative reconstruction algorithms, low kV imaging, and single-heart beat acquisitions hold promise to further reduce dose requirements and improve the safety and robustness of the technique in several circumstances including imaging of heavily calcified vessels, patients with morbid obesity or irregular heart rates, and assessment in the emergency setting. However, it has become clear over recent years that cardiac radiologists need to take further steps towards the development and integration of functional imaging with morphological CCTA assessment to truly provide a comprehensive evaluation of the heart. Computed tomography myocardial perfusion imaging, including both dynamic and static dual-energy approaches, has demonstrated the ability to directly assess and quantify myocardial ischemia with simultaneous CCTA acquisition with a reasonable contrast medium volume and radiation dose delivered to the patient. In order to promote CCTA in the clinical and research environments, radiologists should prepare to embrace the change from morphological to functional imaging, furnishing all the necessary resources and information to referring clinicians.

Noninvasive Detection of Coronary Artery Stenosis Using 16-slice Spiral CT: a Comparison with Selective X-ray Coronary Angiography

The role of 16-slice spiral CT was selective X-ray coronary angiography （SCA） who were suspected of having coronary heart evaluated in the diagnosis of coronary stenosis, with serving as the reference standard. Sixty-five patients disease, without percutaneous transluminal coronary angioplasty or coronary bypass-grafting, were investigated using 16-slice CT. Eight patients with pre-scan heart rate of more than 80 beats/min were given β-blockers. After the retrospectively ECG-gated axial imaging reconstruction, volume redering （VR）, multi-planar reconstruction （MPR）, curved MPR and maximum intensity projection （MIP） were used to reconstruct. Every segment of coronary artery with a diameter ≥1.5 mm was assessed, and the presence on CT with a stenosis exceeding 50 % diameter reduction was compared with that on SCA. The reasons which lead to some segments unevaluable were analysed. Compared with SCA, 93 % coronary segments and 94 % main branches were evaluable. Residual cardiac motion artifacts, severe calcification and poor opacification made 58 %, 28 % and 14 % of the remaining 60 segments unevaluable respectively. Without routine administration of β-blockers, good coronary imaging quality can be acquired using 16-slice spiral CT. It is a reliable noninvasive method for detection of obstructive coronary artery disease.

Subtraction Perfusion CT: A Technical Note

It is challenging to attempt to obtain CT perfusion (CTP) images of the hyperdense tissues, which could conceal the density of contrast material during perfusion study. We report a new technique of subtraction CTP (SCTP) to compensate the shortcomings. SCTP post-processed by perfusion software for the data of post-perfusion images subtracting pre-perfusion corresponding images slice by slice in CTP source images is technically feasible without any adverse effects on patients. It provides a new functional imaging with quantitatively hemodynamic indexes of tissue microcirculation and reflects accurately the change of blood flow in tissues and organs.

Cerebral pseudoinfarction due to venoarterial extracorporeal membrane oxygenation:A case report

BACKGROUND Neurological complications are common in the management of venoarterial extracorporeal membrane oxygenation(VA-ECMO),with most patients requiring sedation and intubation,limiting the assessment of neurological function.Therefore,we must rely on advanced neuroimaging techniques,such as computed tomography angiography(CTA)and computed tomography perfusion(CTP).Because ECMO changes the normal blood flow pattern,it may interfere with the contrast medium in some special cases,leading to artifacts and ultimately misleading clinical decisions.CASE SUMMARY A 61-year-old man presented to a local hospital with chest tightness and pain 1 d prior to presentation.The patient was treated with VA-ECMO after sudden cardiac and respiratory arrest at a local hospital.For further treatment,the patient was transferred to our hospital.The initial consciousness assessment was not clear,and routine CTP was performed to understand the intracranial changes,which suggested a large area of cerebral infarction on the right side;however,the cerebral oxygen was not consistent with the CTP results,and the reexamination of CTA still suggested a right cerebral infarction.To identify this difference,bedside transcranial Doppler was performed,and the blood flow on both sides was different.By reducing the ECMO flow,CTP reexamination showed that the results were normal and consistent with the clinical results.On day 3,the patient was alert and showed good limb movements.CONCLUSION In patients with peripheral VA-ECMO,cerebral perfusion confirmed by CTP and CTA may lead to false cerebral infarction.

Multislice spiral CT angiography in evaluation of liver transplantation candidates

BACKGROUND: Orthotopic liver transplantation has be- come the treatment of choice for patients with end-stage liver disease. This study was designed to study whether multislice spiral CT angiography (MSCTA) could be used for preoperative evaluation for orthotopic liver transplanta- tion candidates. METHODS: Eighty consecutive potential candidates for liver transplantation were evaluated with dual-phase three-di- mensional CT angiography (3DCTA). The arterial-phase was used to create vascular maps of the celiac axis (inclu- ding the origin of the hepatic common artery, left gastric artery and splenic artery) and origin of the superior mesen- teric artery. The portal venous-phase was used to analyze portal vein thrombosis and collateral vascularization of the portal vein. Statistical analyses were made using the chi- square test for differences between hepatic arterial anatomy of 80 patients and Michel's anatomy of 200 patients. Appearance of MSCTA and operative results of 16 patients were analyzed. RESULTS; Sixty-two patients (77.5%) showed conven- tional and 18 (22.5%) nonconventional hepatic arterial anatomy. A significant difference was found between the two groups in anatomy of the hepatic artery (P <0.05). Celiac axis stenosis was observed in 6 patients, SA aneu- rysm in 2, small-caliber hepatic arterial vessels in 2, and portal vein thrombosis in 15. Vascular structures of 16 ope- rative patients were well defined. CONCLUSION: As a noninvasive examination, MSCTA can provide a comprehensive preoperative vascular evalua- tion for liver transplantation candidates.

The value of CT pulmonary angiography to the diagnosis of right ventricular dysfunction due to acute pulmonary embolism:compared with ultrasonographic cardiography

To analyze the value of CT pulmonary angiography（CTPA） in assessing right ventdcular dysfunction（RVD） after acute pulmonary embolism. Methods：Thirty-six patients with CTPA-confirmed PE who underwent ultrasonic cardiography（UCG） within the ensuing 24 hours were retrospectively reviewed. According to the severity of the disease, the patients were divided into the massive PE group（24 cases） and non-massive PE group（12 cases） respectively. CT scans were analyzed for findings suggestive of RVD. Scans were considered positive for RVD if the right ventricle was dilated（RVd/LVd 〉 1） or if the interventricular septum was straightened or deviated towards the left ventricle. Results were then compared with the results of UCG to estimate the value of CTPA in detecting RVD associated with PE, Results：In all cases, compared with UCG, the diagnostic sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive value of CTPA was 84.61%, 78.26%, 3.892, 0.197, 68.75% and 90% respectively. Kappa value was 0.60, which suggested moderate agreement between CTPA and UCG in the whole level. In the massive PE group, the diagnostic sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value of CTPA was 84.61%, 72.73%, 3.103, 0.212, 78.57% and 80% respectively. Kappa value was 0.58, which suggested moderate agreement between CTPA and UCG in the massive PE group. In the non-massive PE group, the diagnostic specificity of CTPA was 83.33%. By statistics, the value of RVd/LVd had significant difference between the massive PE and the non-massive PE group. Conclusion：CTPA can reliably detect RVD through the evaluation of cardiac morphology. However, this result requires confirmation using a larger prospective cohort study.

The dynamic study of the pulmonary artery obstruction degree and the right ventricular function in massive pulmonary embolism on CT pulmonary angiography

Objective： To analyze the value of CTPA in assessing the dissolve of embolus and the function of the right ventricle dynamically. Methods：Twenty-three cases of massive pulmonary embolism were analyzed retrospectively. The pulmonary artery obstruction index and the right ventricular function parameters were collected and analyzed on CTPA before thrombolytic therapy, 24 hours and 14 days after therapy, respectively. Results：The pulmonary artery obstruction index decreased gradually, and there was significant difference before therapy, 24 hours and 2 weeks after therapy. Twenty-four hours after therapy, the maximal short axes diameter and the maximal transverse area of right ventricle（RVd, RV~） decreased significantly, the maximal short axes diameter and the maximal transverse area of left ventricle（LVd, LVs） increased significantly, and the RVd/LVd, RVs/LVS decreased apparently. The pulmonary artery symbolic pressure before and 24 hours after therapy were apparently different. There was no significant difference between azygos vein, the super vena cava, the main pulmonary artery and vein reflux before and after therapy. Conclusion：CTPA can evaluate the pulmonary artery obstruction degree and right ventricular function dynamically.

头颈部CTA联合颅脑灌注一站式检查在预测脑梗死预后中的临床价值

目的探究头颈部计算机断层扫描血管成像(CTA)联合颅脑灌注(CTP)一站式检查在预测脑梗死预后中的临床价值。方法选取2019年11月-2022年11月广西壮族自治区民族医院和广西壮族自治区人民医院收治的脑梗死患者100例,分为预后良好组68例和预后不良组32例。2组均进行头颈部CTA联合CTP检查并比较相关参数差异;ROC曲线分析CTA、CTP相关参数对脑梗死预后的评估价值。结果预后不良组入院NIHSS评分和入院mRS评分高于预后良好组(P<0.05);预后不良组平均ASPECTS评分、脑血容量(CBV)、脑血流量(CBF)低于预后良好组,ASPECTS评分<5分人数、平均通过时间(MTT)、峰值时间(TTP)高于预后良好组(P<0.05);Pearson相关分析结果显示,ASPECTS评分、CBV、CBF均与NIHSS评分、mRS评分呈负相关,MTT、TTP均与入院NIHSS评分、mRS评分呈正相关(P<0.05);ROC曲线显示,ASPECTS评分、CBV、CBF、MTT、TTP的曲线下面积分别为0.878、0.771、0.870、0.826、0.885,上述指标联合诊断的曲线下面积为0.990(P<0.05)。结论头颈部CTA联合颅脑CTP一站式检查能更好地预测患者预后,值得推广。

低剂量头颈CTA及全脑CTP技术在颈动脉源性脑灌注异常评估中的应用

目的探究低剂量头颈计算机断层扫描血管成像(CTA)及全脑计算机断层扫描灌注成像(CTP)技术在脑灌注评估中的应用。方法86例超声检查提示颈动脉狭窄患者、50例健康体检者进行CTA和CTP检查,比较脑灌注参数[脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)和达峰时间(TTP)]及CTP参数异常脑功能区分布。结果狭窄组前循环供血动脉CBF、CBV均小于对照组(P<0.01),MTT、TTP均大于对照组(P<0.01)。随着狭窄程度加重,全脑CBF、CBV、MTT、TTP异常区域占全脑容量的百分比明显增加(P<0.01)。结论低剂量头颈CTA及全脑CTP技术在颈动脉源性脑灌注异常的评估中具有重要价值。

宽体探测器CT行全脑灌注成像联合头颈部CTA扫描的应用价值

目的探讨采用宽体探测器CT行全脑灌注联合头颈部CTA一站式扫描的价值。方法选取接受一站式全脑灌注联合头颈CTA模式扫描的40例患者作为A组,全脑CT灌注扫描的40例患者作为B组,对两组患者图像质量进行主观评分及客观评价,比较两种扫描模式下的CT灌注图像质量、CTA图像质量及辐射剂量等。结果两组CTA图像质量均满足诊断要求,且主观评分差异无统计学意义(P>0.05);客观参数评价中A组颈内动脉末端CT值SI血管(584.88±142.11)HU高于B组(447.93±85.14)HU,差异有统计学意义(P<0.05),其余指标噪声(SD)、信噪比(SNR)、对比噪声比(CNR)差异均无统计学意义(P>0.05)。两组CT灌注图像质量均满足诊断要求,其中A组脑血容量(CBV)图像质量略低于B组,差异有统计学意义(P<0.05),其余脑血流量(CBF)、平均通过时间(MTT)、血流峰值时间(Tmax)图像质量主观评分差异无统计学意义(P>0.05)。A组辐射剂量、CT剂量指数低于B组,差异有统计学意义(P<0.05)。结论宽体探测器用于一站式全脑CT灌注成像联合头颈CTA扫描方式具有一定的优势,能够保证图像质量满足诊断要求,并且可以降低辐射剂量、缩短扫描时间。

动态CT血管造影联合CT灌注成像评估预测急性缺血性脑卒中预后研究

目的:探讨动态CT血管造影(CTA)联合CT灌注成像(CTP)评估预测急性缺血性脑卒中(AIS)预后的价值。方法:选取141例AIS患者,根据预后情况分为预后良好组(106)和预后不良组(35例),比较两组患者临床基线资料、CTA及CTP参数差异,分析AIS患者预后不良因素,探讨CTA联合CTP预测AIS患者预后的价值。结果:预后不良组年龄>60岁比例明显高于预后良好患者,差异有统计学意义(x^(2)=6.671,P<0.05);预后不良组患者入院时美国国立卫生研究院卒中量表(NIHSS)评分及梗死面积明显高于预后良好患者,差异有统计学意义(t=12.096,t=10.706;P<0.05)。预后不良组ASPECTS侧支循环评分≤3分者显著高于预后良好组,差异有统计学意义(x^(2)=9.567,P<0.05)。预后不良组平均通过时间(MTT)、达峰时间(TTP)及相对平均通过时间(rMTT)明显高于预后良好患者,相对脑血容量(rCBV)明显低于预后良好患者,差异有统计学意义(t=6.395,t=6.395,t=3.379,t=-3.905;P<0.05)。Logistic回归分析显示,年龄、NIHSS评分、ASPECTS侧支循环评分≤3分、rCBV及rMTT是AIS预后不良的影响因素(OR=1.575,OR=1.855,OR=1.654,OR=0.717,OR=1.374;P<0.05)。ASPECTS侧支循环评分联合rCBV、rMTT预测患者预后不良的受试者工作特征(ROC)曲线下面积为0.820,显著高于ASPECTS侧支循环评分、r CBV及r MTT单独预测(x^(2)=5.543,x^(2)=6.832,x^(2)=6.172;P<0.05)。结论:CTA联合CTP在预测AIS预后方面有一定价值,其中ASPECTS侧支循环评分联合r CBV、r MTT预测患者预后不良价值较高。