【摘要】 目的:分析全脑动态容积CT血管造影CT灌注成像(CTA-CTP)一体化技术对急性缺血性脑卒中(CIS)患者的临床应用价值。方法:选择医院收治的98例CIS患者,从出现症状至基线影像学检查时间间隔<24 h,患者均完成CTP-CTA一体化检查,比较各患者脑区域全脑病灶脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)等灌注参数图,分析对比患者梗死区与健侧区各项灌注参数的差异。结果:98例患者中梗死灶78例,半暗带85例。CTP检查发现,梗死区的CBF、CBV水平明显低于对应健侧区,MTT及TTP水平明显高于对应健侧区,差异有统计学意义(t=17.253,t=25.009,t=8.821,t=19.025;P<0.05);对应健侧区、半暗带及梗死区三部位CBF、MTT和TTP两两相比,差异有统计学意义(F=157.580,F=117.680,F=59.960;P<0.05),梗死区CBV水平与对应健侧区及半暗带差异有统计学意义(F=266.030,P<0.05)。超CIS(超急性缺血性脑卒中)患者18例,CIS患者80例。CTA检查额顶叶病变阳性率为47.37%,基底节-侧脑室层面的病变阳性率为45.45%,缺血范围较大者阳性率为81.48%。结论:CTA-CTP一体化技术可清楚显示狭窄或闭塞的动脉及形成的侧支循环,并可准确评估急性期缺血性脑卒中患者的脑灌注情况,有效评估脑组织侧支循环状态和患者预后情况。更多还原

【Abstract】 Objective: To analyze the clinical application value of whole brain dynamic volume computed tomography angiography-computed tomography perfusion(CTA-CTP) imaging in patients with cerebral ischemic stroke(CIS).Methods: 98 patients with CIS who admitted to hospital were selected. The interval from occurring symptom to baseline imaging examination of them was within 24 hours. All patients underwent integrated examination of CTACTP. The perfusion parameters charts included cerebral blood flow(CBF), cerebral blood volume(CBV), mean transit time(MTT) and time to peak(TTP) of whole brain lesions in brain region of each patient were compared,and differences of each perfusion parameter of patients between infarcted region and healthy side were analyzed and compared. Results: Among the 98 patients, 78 cases occurred infarction and 85 cases occurred ischemic penumbra.CTP examination showed that the levels of CBF and CBV in the infarcted region were significantly lower than those in the corresponding healthy side region, and the levels of MTT and TTP in that region were significantly higher than those in corresponding healthy side region(t=17.253, t=25.009, t=8.821, t=19.025, P<0.05). There were significant differences in pairwise comparison among the corresponding healthy side region, ischemic penumbra and infarcted region for CBF, MTT and TTP(F=157.580, F=117.680, F=59.960, P<0.05). There was significant difference in CBV level between the infarcted region, the corresponding healthy side region and ischemic penumbra(F=266.030,P<0.05). 18 patients were hyper CIS, and 80 patients were CIS. The positive rate of frontal parietal lobe lesions was 47.37% as the CTA examination, and the positive rate of the lesions of basal ganglia-lateral ventricle was 45.45%, and the positive rate of patients with larger ischemic range was 81.48%. Conclusion: CTA-CTP integrated technique can clearly reveal the arteries with stenosis or occlusion and the formed collateral circulation. It can not only accurately assess the conditions of cerebral perfusion of patients with cerebral ischemic stroke at acute stage, but also effectively assess the state of collateral circulation of brain tissue and the prognosis of patients.更多还原