多层螺旋 CT 灌注成像在急性脑梗死患者的应用研究

摘要

目的：探讨急性脑梗死患者多层螺旋 CT 灌注成像特点,及其与临床预后的关系。方法选择符合标准的患者40例,行 CT 灌注成像检查,计算脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)及峰值时间(TTP)；分别在入院时和治疗后14d 采用美国国立卫生研究院卒中量表(NIHSS)评价临床神经功能缺损,计算缺血脑组织的可恢复比率(PRR)和神经功能恢复比率。结果脑梗死病灶中心 CBV 及 CBF 最低,健侧最高,而缺血半暗带居中,差异有统计学意义(P <0．05)；脑梗死病灶中心 MTT 及 TTP 最高,健侧最低,而缺血半暗带居中,差异有统计学意义(P <0．05)。 PRR 与患者入院时 NIHSS 评分无相关性(r =-0．227,P >0．05)；PRR 与患者治疗14d 时 NIHSS 评分存在负相关性(r =-0．340, P <0．05)；PRR 与患者神经功能恢复比率存在正相关性(r =0．467,P <0．05)。结论多层螺旋 CT 灌注成像可以反映急性脑梗死病灶及其周围血液动力学变化,PRR 与神经功能恢复密切相关,可以为临床治疗提供可靠的理论依据。%Objective To investigate the characteristics of multi-slice spiral CT perfusion imaging in patients with acute cerebral infarction and its relationship with clinical prognosis. Methods Forty patients who met the inclusion criteria were selected to undergo CT perfusion imaging,and their cerebral blood flows ( CBFs),cerebral blood volumes ( CBVs),mean transit times (MTTs) and transit time peaks (TTPs) were calculated. Clinical neurologic impairment was assessed with the National Institutes of Health Stroke Scale (NIHSS) and the potential recuperation ratio (PRR) of the ischemic brain tissue and the neural functional recovery ratio were calculated on admission and at day 14 after treatment,respectively. Results CBV and CBF were lowest in cen-tral cerebral infarction lesions,highest contralaterally and median in the ischemic penumbra,and the difference was statistically sig-nificant (P < 0. 05). MTT and TTP werehighest in central cerebral infarction lesions,lowest contralaterally and median in the is-chemic penumbra,and the difference was statistically significant (P < 0. 05). PRR was independent of patients’ NIHSS scores on admission (r = - 0. 227,P > 0. 05),negatively dependent of those at day 14 after treatment (r = - 0. 340,P < 0. 05) and positive-ly dependent of patient’s neural functional recovery ratio (r = 0. 467,P < 0. 05). Conclusion Multi-slice spiral CT perfusion im-aging can reflecthemodynamic changes in acute cerebral infarction lesions and their perihemodynamic changes. PRR is closely de-pendent of the neural functional recovery. It can serve as a reliable theoretical basis for clinical treatment.