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目的评价全脑CT灌注成像加同步CT血管造影(CTA)对早期缺血性脑梗死的诊断价值。方法对20例缺血性卒中发作2~24h病例分别行常规非强化CT(NCCT),CT全脑灌注成像(PWCT)及灌注后70s的延时扫描(DCT),分别测量低灌注区中心,周边及健侧相对应区CT值,计算病变中央和对侧灌注血液容积(PBV),PWCT作为CTA源图像重建CTA,判断颅内大血管阻断或狭窄及分支缺损情况,灌注延时相了解侧支循环改变,PWCT用密度差法处理,1周至1个月后复查CT、MR确定最终梗死区面积,用SPSS软件统计分析。结果20例缺血性卒中NCCT+PWCT+CTA未发现异常10例,其中临床及复查CT、MR证实短暂性脑缺血发作(TIA)6例,腔隙性梗死4例,10例PWCT低灌注区中心、周边内侧与外侧和健侧对应区CT值比较差异具有统计学意义(P<0·01),而病灶中心、周边内和外之间差异无统计学意义(P>0·05),病变侧和健侧PBV值差异有统计学意义(P<0·05),所有最终梗死区面积较低灌注区增大,增大百分比与缺血时间呈中度负相关,R2=0·42,CTA显示左大脑中动脉阻断2例,左大脑中动脉前、中分支缺如3例,NCCT、PWCT及CTA的敏感度分别为28·5%、71·4%和35·7%,延时相显示不对称充盈血管5例。结论CT全脑灌注像加同步CTA对早期脑梗死的诊断不失为一种简便、省时和有效的方法,可明确低灌注区的存在及其大小、位置和相对应供血动脉的情况,对半暗带区也可作出一定程度的推测,可为临床早期溶栓治疗提供半定量的形态学依据。
Objective To evaluate the diagnostic value of whole brain CT perfusion imaging and synchronous CT angiography (CTA) in early ischemic cerebral infarction. Methods Twenty patients with ischemic stroke were enrolled in this study. Conventional non-enhanced CT (NCCT), CT whole-brain perfusion imaging (PWCT) and delayed scanning (DCT) of 70s after perfusion were performed in 2 to 24h of ischemic stroke. Peripheral and contralateral CT values corresponding to the lesion to calculate the central and contralateral perfusion volume (PBV), PWCT as CTA source image reconstruction CTA, to determine intracranial vascular occlusion or stenosis and branch defect, perfusion delay phase understanding Collateral circulation changes, PWCT density difference method, 1 week to 1 month after the review of CT, MR to determine the final infarct size, using SPSS software statistical analysis. Results Twenty patients with ischemic stroke NCCT + PWCT + CTA showed no abnormalities in 10 cases. Among them, 6 cases of transient ischemic attack (TIA), 4 cases of lacunar infarction, 10 cases of PWCT hypoperfusion There were significant differences in CT value between the center of the area, the medial and lateral circumflex and the contralateral corresponding area (P <0.01), but there was no significant difference between the center and periphery of the lesion (P> 0.05) (P <0 · 05). The area of the final infarct area increased in all cases, the percentage of increase was moderately negative correlated with the time of ischemia, and R2 = 0 · 42, CTA showed two cases of middle cerebral artery occlusion in the left middle cerebral artery and three cases in the middle and middle middle cerebral artery lacking. The sensitivities of NCCT, PWCT and CTA were 28.5%, 71.4% and 35.7% , Delayed phase showed asymmetric filling of blood vessels in 5 cases. Conclusions CT whole brain perfusion imaging and synchronous CTA can be used as a simple, time-saving and effective method to diagnose early cerebral infarction. It can confirm the existence of low perfusion area, its size, location and the corresponding feeding artery, The band may also make a certain degree of speculation, which can provide semi-quantitative morphological evidence for early thrombolytic therapy.