急性缺血性脑血管病76例多模式CT影像学分析

摘要

Objective To analyze the image performance of multimodal CT for acute ischemic cerebrovascular disease(AICVD) in 76 patients .Method 76 patients with AICVD underwent one-stop CT and CTP-CTA of internal carotid system. The parameter maps of cereabral blood flow(CBF), cerebral blood volume (CBV),mean transit time(MTT) and time to peak(TTP) were analyzed. meanwile dynamic CT angiography(CTA) images were obtained. MRI was performed within 3 days of admission .Results In the image of CT perfusion for 76 patients, to analyzed region of interest, 59 cases were found abnormal region of interest and 17 cases were not found. Include 47 cases acute cerebral infarction and 12 TIA in 59 patients, the characteristic image of abnormal CTP: 4 patients in 4.5 hours : including decrease in CBF and normal in CBV, prolonged in TTP and MTT of 2 patinets, another 2 patients showed decrease in CBF and reduce in CBV, prolonged in TTP and MTT; in 4.5-6h of 4 patients : including decrease in CBF and normal in CBV, prolonged in TTP and MTT of 2 patinets,another 2 patients showed decrease in CBF and CBV , prolonged in TTP and MTT; in 6-24h of 39 patients : abnormal perfusion region same as cerebra infarction of 30 patients: obvious decrease in CBF and CBV, prolonged in TTP and MTT. abnormal perfusion region conform with clinical responsibility focus in 12 patients of TIA: prolonged in TTP and MTT, normal or decrease in CBF, increase in CBV; CTA demonstrated vascular stenosis in 5 cases and occlusion in 10 cases.7 of them with visible collateral vessel formation had small finalinfarct.Conclusion Multimodal CT can show changes of cerebral blood flow parameters and the degree of stenosis of the corresponding the feeding artery in AICVD. Has certain reference value to the clinical diagnosis and treatment, multimodal CT mainly apply in the cerebral hemisphere stroke, especially with clinical value.%目的 探讨76例急性缺血性脑血管病(AICVD)的多模式CT影像学特点.方法 采用320排多层螺旋CT对76例AICVD(发病时间<24h)患者急诊进行CT平扫(NCCT)+CT灌注成像(CTP)+CT血管成像(CTA)一站式扫描检查,分析灌注区脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)等灌注参数变化及CT血管成像(CTA),并于入院后3d内行头颅MRI,评估其脑灌注特点及血管影像.结果 在获取的76例CTP数据中,通过感兴趣区识别划分筛查,有59例患者有明确的异常CTP,有17例患者未发现明确感兴趣区.59例异常CTP中包括急性脑梗死47例,短暂性脑缺血发作(TIA)12例.急性脑梗死患者异常CTP特点:发病在4.5h以内的4例患者CTP表现为患侧CBF均较健侧下降,CBV正常或者轻度增高,MTT、TTP延长;发病时间在4.5~6h内的4例:其中2例CTP表现为CBF降低,CBV正常,MTT、TTP延长,2例表现为CBF降低,CBV轻度降低,MTT、TTP延长;发病时间在6~24h内的39例:其中30例梗死区与CTP异常脑灌注区部位一致,均表现CBF明显降低,CBV明显降低,MTT、TTP延长;12例TIA患者CTP均发现与临床症状相对应的灌注异常:MTT、TTP延长,CBF正常或减低,CBV升高.CTA发现责任动脉重度狭窄5例,血管闭塞10例,7例可见血流缓慢,排空延迟及侧支血管形成.结论 多模式CT能够对AICVD提供血流灌注参数的变化及血管情况、供血区的血流动力学变化,对临床诊治具有一定参考价值,主要用于评估大脑半球卒中,多模式CT有临床价值.