16层螺旋CT脑灌注成像在急性脑梗死诊断中的应用价值

摘要

Objective To explore the early diagnostic value of multi-slice CT(MSCT) cerebral perfusion imaging in acute cerebral infarction.Methods Conventional CT and CT perfusion imaging were performed in 34 patients with diagnosed clinically acute cerebral infarction.The time to peak (TTP),cerebral blood flow (CBF) and cerebral blood volume (CBV) were evaluated.All patients were counterchecked by regular CT in 3～7 days.And 20 normal volunteers were enrolled as control.Results In 34 cases,15 cases were diagnosed as cerebral infarction obtained regular CT positive results.In 19 having regular CT negative results,17 had cerebral infarction,and the other 2 had transient ischemic attack (TIA).32 cases were confirmed by CTP as having ischemic lesions,whose cerebral blood flow (rCBF),time to peak (rTTP) in 32 cases with CTP positive were found obviously changed.The side of ischemic lesion as compared with the opposite,and the core of ischemic lesion as compared with peripheral zone were found changed significantly (P ＜0.01).In the present series of 34 patients,routine CT scan had sensitivity of 44.11％ and specificity of 71.42％.CTP had sensitivity of 94.11 ％ and specificity of 100％.Conclusion CTP can be used in diagnosis of early stage of acute cerebral infarction.The quantitative evaluation can differentiate the core of infarction from ischemic penumbra.It can provide valuable information for doctor to choose suitable therapy project.%目的 探讨16层螺旋CT(MSCT)脑灌注成像对急性脑梗死的早期诊断价值.方法 对34例临床拟诊为急性脑梗死的患者行头颅CT平扫,脑CT灌注成像.评价脑CT灌注成像的达峰时间(TTP),脑血流量(CBF),脑血容量(CBV).全部病例3～7天内复查CT及临床随访.选取20名正常志愿者作为对照.结果 常规CT平扫显示:34例急性脑梗死患者在发病24h内,15例诊断为急性脑梗死,19例未见异常,后经复查CT及临床随访证实,2例为短暂性脑缺血发作(TIA),17例为急性脑梗死.脑CTP显示:34例急性脑梗死患者在发病24h内,32例脑CTP灌注异常,2例脑CTP灌注正常,脑CTP显示患者感兴趣区内脑血流量(rCBF)、脑血容量(rCBV)、对比剂达峰时间(rTTP)明显改变,病灶侧与对照侧、病灶中心区与周边区比较,差异有显著意义(P＜0.01).CT平扫的敏感度44.11％,特异度71.42％;CTP的敏感度94.11％,特异度100％.结论 脑CTP能够早期诊断急性脑梗死,定量分析可区分中心梗死区与缺血半暗带区,有助于临床医生早期选择治疗方案.