【摘要】 目的：探讨全脑CT灌注（CTP）对小体积急性脑梗死（ACI）灶的诊断价值，并进一步分析可能对诊断产生影响的各种因素。方法：选取86例疑似ACI患者，初步完成全脑CTP检查后，以MRI或CT后续复查来确定梗死灶数目，通过弥散加权成像（DWI）进一步证实，符合小体积ACI灶（体积≤8 mL）患者共58例，评价全脑CTP及各参数诊断小体积ACI灶的灵敏度、特异度；依据发病时间、病灶部位及最大直径的差异性，分析全脑CTP对不同类型病灶的诊断价值。结果：全脑CTP共诊断出41例患者，检出小体积ACI灶共55个，MRI或CT共检出70个病灶。诊断过程中全脑CTP灵敏度为67.14%(47/70)，各参数比较，脑血容量（CBV）的特异度最高，达到92.86%(26/28)。在各影响因素中，CTP对位于皮质/皮质下和丘脑、基底节区的小体积ACI灶诊断准确度曲线下面积（AUC）分别为0.886和0.675;CTP对直径≤15 mm病灶的灵敏度为40.74%(11/27)，而对直径>15 mm者灵敏度为83.72%(36/43)，差异有统计学意义（P<0.05）；全脑CTP最终检出的病灶体积和直径中位数分别为1.90 mL和17.0 mm，未检测出的病灶体积和直径中位数分别为0.42 mL和11.0 mm，差异均有统计学意义（P<0.05）。但是发病时间差异尚未对CTP的诊断灵敏度产生影响（P=0.824）。结论：全脑CTP对小体积ACI灶诊断具有一定的价值；CTP对较大直径病灶及位于脑浅表皮质、皮质下病灶诊断准确度较高。更多还原

【Abstract】 Purpose: To investigate the diagnostic accuracy of whole brain CT perfusion(WB-CTP) in small volume acute cerebral infarction(ACI) and to further analyze the factors influencing the diagnosis.Methods: A total of 86 patients who underwent initial WB-CTP because of suspected ACI. The number of infarcts were confirmed by follow-up MRI or CT.Diffusion weighted imaging(DWI) further confirmed that 58 patients were with small volume ACI(volume ≤8 mL). The sensitivity and specificity of WB-CTP and each parameter map in diagnosing small volume ACI were evaluated.The diagnostic value of WB-CTP for different types of lesions was analyzed according to the difference of the time occurrence, the location and the maximum diameter of lesions. Results: A total of 55infarctions were detected by WB-CTP from 41 patients, and 70 lesions were detected by MRI or CT. The sensitivity of WB-CTP was 67.14%(47/70), and the specificity of cerebral blood volume(CBV) was the highest, up to 92.86% (26/28). Among the influencing factors, the area under curve(AUC) for CTP to identify small volume infarction located in cortex and subcortex, thalamus and basal ganglia region was 0.886 and 0.675, respectively.The sensitivity for CTP to detect lesions with diameter of 15 mm or less and the diameter greater than 15 mm was 40.74%(11/27) and 83.72%(36/43), respectively, and the difference was with statistical significance(P<0.05). The median diameter and volume of lesions detected by whole brain CTP were 17.0 mm and 1.90 mL, respectively, while the diameter and volume of lesions not detected by whole brain CTP were 11.0 mm and 0.42 mL, respectively, and the difference was with statistical significance(P<0.05).However, the difference in onset time did not affect the diagnostic sensitivity of CTP(P=0.824).Conclusions: The WB-CTP has the value of diagnosis for small-volume infarction.The lesions with larger diameter and in cortex or subcortex were diagnosed more accurately by WB-CTP.更多还原