【作者】 吕京光； 柳澄； 武乐斌； 满晓； 冷振璞；

【Author】 LU Jing-guang, LIU Cheng, WU Le-bin,et al. Shandong Medical Imaging Research Institute, Jinan 250021, China

【机构】 山东省医学影像学研究所； 山东省立医院神经内科；

【摘要】 目的:应用多层螺旋CT(MSCT)采用CT灌注成像(CTPI)与CT血管成像(CTA)相结合的技术探讨急性缺血性脑血管病(AICVD)的超早期诊断,并评价它们在区分短暂性脑缺血发作(TIA)与脑梗死(CI)中的作用以及梗死体积与供血动脉状况的关系。方法:对46例AICVD患者行CT平扫、CTPI和CTA检查。按病变类型分为CI组和TIA组。CI组按病灶大小分为大、中、小体积梗死组。对比观察AICVD患者的CT平扫、CTPI和CTA图像;分析CI组病灶大小与CTA变化的关系。结果:46例AICVD患者均于发病6h内就诊。CT平扫12例TIA患者均未见异常;34例CI患者29例未见异常,仅5例显示略低密度灶。CTPI未见异常者16例,其中TIA12例,小体积C14例;灌注异常者30例,患侧与健侧、病灶中心区与周边区rCBF、TIP的差异在统计学上有显著性意义。CTA显示12例TIA患者10例未见异常改变,2例患侧供血动脉变细;34例CI患者30例病变区相应的供血动脉不同程度的狭窄,4例小体积CI患者未见异常改变。结论:利用MSCT的优势可以在较短的时间内仅使用90ml对比剂完成CTPI和CTA检查以及后处理工作。CTPI联合CTA能够超早期诊断CI,并同时从功能和形态学上综合分析MCVD的程度和原因,获得更详细的信息,为临床医师尽早进行合理治疗,提供客观的影像学依据。更多还原

【Abstract】 Objective:To investigate the diagnosis of ultra-early AICVD and evaluate the roles in differentiating transient ischemic attack(TIA)from cerebral infarction(CI), and the relation between the volume of CI and situation of supplying artery by using multislice spiral CT(MSCT)and adopting the technique of combining CTPI with CTA. Methods:Examinations of plain CT scan, CTPI and CTA were performed in 46 cases with AICVD.The patients were divided into two groups,CI group and TLA group according to the type of the lesions. CI group was composed of large, middle and small volumes of the infarction according to the size of the lesions. The plain CT scans and CTPI and CTA of the patients with AICVD were observed and compared, and the relation between the size of the lesions and CTA findings was analyzed in CI group. Results:Onset of all 46 cases with AICVD was within 6 hours. On plain CT scans, nothing was found in 12 cases with TIA, and light lower density was showed in 5 cases and normal study in 29 cases of 34 cases with CI. CTPI showed normal study in 16 cases, including 12 cases with TIA and 4 cases with smallsize infarction, and abnormal study in 30 cases. The changes of rCBF and TTP were obvious in 30 cases with CTPI abnormality. There was statistically significant difference between lesion and contralateral side, and between center and peripheral area of the lesion. On CTA, normal study was displayed in 10 cases with TIA and narrow of supplying arteries of the lesions in 2 cases with TIA. There were different-degree narrowness of supplying arteries of the lesions in 30 of 34 cases with CI and 4 cases with small size CI were normal. Conclusion:By using the advantage of MSCT and applying 90ml contrast material, the examination of CTPI and CTA and post processing may be finished in shorter time. The examination of combining CTPI with CTA could diagnose AICVD in ultraearly stage, and the degree and cause of AICVD could be analyzed in function and morphology, and more detailed information was obtained and objective imaging evidence was supplied for clinic treatment reasonably.更多还原