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目的 探讨全脑CT灌注成像联合头颈部CT血管造影(CTA)在急性缺血性脑卒中诊断中的应用价值.方法 选择2016年11月至2018年11月在杭州市大江东医院神经内科急诊就诊的急性缺血性脑卒中患者220例为研究对象.对所有患者进行CT平扫后,再进行全脑CT灌注成像和头颈部CTA检查.记录辐射剂量,通过头颈部CTA检查分析所有患者缺血病变节段及其狭窄情况,全脑CT灌注成像分析所有患者的局部脑血流显像(rCBF)、组织灌注量(rCBV)和平均通过时间(MTT),并且比较两种检查方法的诊断效能.结果 头颈部CTA对血管狭窄分析,狭窄血管段主要分布在M1～ M3段(3例闭塞,11例梗阻≥50％,19例30％≤狭窄＜50％)、A1～A3段(4例梗阻≥50％,7例30％≤狭窄＜50％)和基底动脉(2例闭塞,6例梗阻≥50％,11例30％≤狭窄＜50％).全脑CT灌注成像通过自身不同区域比较,对照区域rCBF高于缺血半暗带区且高于梗死区域,其rCBF分别为(50.31 ±11.21)100 g/min、(34.45 ±22.17)100 g/min和(6.87±3.52) 100 g/min,差异均有统计学意义(t=17.81、19.14,均P＜0.05);对照区域rCBV高于缺血半暗带区且高于梗死区域,其rCBV分别为(3.35±1.01) mL/100g、(2.87±0.55) mL/100g和(6.87±0.51)mL/100g,差异均有统计学意义(t =6.47、9.19,均P＜0.05);对照区域MTT低于缺血半暗带区且低于梗死区域,其MTT分别为(4.52±1.21)s、(7.88±1.01)s和(11.81±1.18)s,差异均有统计学意义(t=10.50、13.54,均P＜0.05).两种方法进行一致性比较,kappa值大于0.75,表现为高度一致性.结论 全脑CT灌注成像和头颈部CTA对急性缺血性脑梗死患者的诊断效能差异不大,都能够精确诊断出疾病,其中全脑CT灌注成像能够通过判读缺血半暗区的位置,而头颈部CTA可以根据病变血管的阶段进行分析,两种方法均可以对个体化治疗起到不同的指导作用.“,”Objective To investigate the clinical value of whole brain CT perfusion imaging combined with head and neck CTA in the diagnosis of acute ischemic stroke.Methods From November 2016 to November 2018,the clinical data and medical imaging data of 220 patients diagnosed as acute ischemic stroke in the Department of Neurology,Dajiangdong Hospital were selected.All patients underwent CT scan followed by a CT perfusion scan and a routine cranial CTA.The radiation dose was recorded.The ischemic lesions and their stenosis were analyzed by CTA.CT perfusion imaging was used to analyze regional cerebral blood flow imaging (rCBF),tissue perfusion (rCBV) and mean passage time (MTT) in all patients..And the test performance of the two inspection methods was compared.Results CTA was used to analyze vascular stenosis.The stenotic vessels were mainly distributed in the M1 ～ M3 segment (3 cases of them were completely obstructed,11 cases were obstructed ≥50％,19 cases were 30％ ≤ stenosis ＜ 50％),and A1 ～ A3 segments (4 cases of them were obstructed,7 cases were 30％ ≤ stenosis ＜ 50％),and basilar artery (2 cases of them occlusion,6 cases of ≥ 50％,11 cases of 30％ ≤ stenosis ＜50％).CT perfusion examination was performed in the whole brain.The rCBF of the control area was higher than that of the ischemic penumbra and higher than the infarct area.The rCBF values were (50.31 ± 11.21) 100 g/min,(34.45 ±22.17)100 g/min and (6.87 ± 3.52)100 g/min,respectively,the difference was statistically significant (t =17.81,19.14,all P＜0.05).The region rCBV of the control area was higher than that of the ischemic penumbra and the infarct region,and the rCBV values were (3.35 ± 1.01) mL/100g,(2.87 ± 0.55) mL/100g and (6.87 ± 0.51) mL/100g,respectively,the differences are statistically significant (t =6.47,9.19,all P ＜ 0.05).The MTT in the control area was lower than that in the ischemic penumbra and the infarct area,and the MTT values were (4.52 ± 1.21) s,(7.88 ± 1.01) s and (11.81 ± 1.18) s,respectively,the differences are statistically significant (t =10.50,13.54,all P ＜0.05).The two methods were compared for consistency,and the kappa value was greater than 0.75,showed a high degree of consistency.Conclusion CT perfusion imaging and CTA have little difference in the diagnostic efficacy for patients with acute ischemic cerebral infarction,and can accurately diagnose the disease.CT perfusion imaging can determine the location of the ischemic penumbra,and CTA can be analyzed based on the stage of the diseased vessel.Both two methods can play different guiding role for individualized treatment.