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目的探讨全脑CT灌注成像(CTPI)对发现缺血性脑卒中早期局部自发性再灌注现象的价值。方法回顾分析110例急性期和亚急性早期(6h～10天)缺血性脑卒中患者临床资料及全脑CTPI参数图〔脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)、达峰时间(TTP)和延迟(Delay)图〕。以患者未接受静脉或动脉溶栓治疗,并且首次CT-PI显示梗死脑区CBV减低、复查CTPI显示梗死脑区CBV为正常或增高定义为自发性再灌注区,分别观察各灌注参数图的特点并测量再灌注区和对侧镜像正常脑区各灌注参数值,采用配对t检验比较再灌注区与对侧正常脑区灌注参数值的差异。结果共有15例存在自发性再灌注现象,距发病平均时间为61.5h,自发性再灌注脑区表现为CBV/CBF增高、TTP延长(P<0.05)。结论全脑CTPI能可靠发现脑梗死早期自发性再灌注现象,为临床治疗提供重要信息。
Objective To investigate the value of whole brain CT perfusion imaging (CTPI) in detecting the early local spontaneous reperfusion in ischemic stroke. Methods The clinical data of 110 patients with acute cerebral infarction and acute subacute (6h ~ 10d) ischemic stroke were retrospectively analyzed. The CTPI parameters (cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time MTT), peak time (TTP), and delay graph]. Patients were not treated with intravenous or arterial thrombolysis, and CT-PI for the first time showed reduced CBV in infarcted brain areas. CTPI was rechecked to show normal or elevated CBV in infarcted brain areas as spontaneous reperfusion area. The characteristics of each perfusion parameter map The perfusion parameters were measured in the normal brain regions of the reperfusion area and the opposite side. The paired t test was used to compare the perfusion parameters between the reperfusion area and the contralateral normal area. Results A total of 15 patients had spontaneous reperfusion. The average time from onset to onset was 61.5 hours. The spontaneous reperfusion brain regions showed increased CBV / CBF and prolonged TTP (P <0.05). Conclusion Whole-brain CTPI can reliably detect spontaneous reperfusion in early stage of cerebral infarction and provide important information for clinical treatment.