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目的探讨CT脑灌注成像在基底节区腔隙性脑梗死的应用价值。资料与方法对35例超早期(发病<6 h)基底节区腔隙性脑梗死患者行常规CT头颅平扫及CT脑灌注成像。在常规轴位CT扫描后选取基底节区层面,经肘静脉团注45 ml非离子型对比剂,同时开始持续40 s的单层连续动态扫描,重组的40幅动态图像使用CT脑灌注软件进行处理,获得灌注图像。测量双侧基底节区感兴趣区的局部脑血流量(CBF)及局部灌注达峰时间(TTP),并进行定量分析。结果35例基底节区腔隙性脑梗死患者中有29例被后期追踪CT或MRI证实为基底节区腔隙性脑梗死,其中20例梗死灶直径>5 mm(<20 mm),9例病灶<5 mm;余6例CT复查为阴性而临床诊断为脑梗死。20例梗死灶直径>5 mm(<20 mm)中有17例CT灌注为阳性,表现为CBF明显低于正常侧,TTP明显长于正常侧;另外3例未发现灌注异常区。20例梗死灶直径>5 mm(<20 mm)患者患侧及对侧的局部灌注平均CBF分别为(384.9±118.7)ml.min-1.L-1和(256.2±80.3)ml.min-1.L-1,两者比较差异有统计学意义(t=5.898,P<0.01);患侧及对侧的局部平均TTP分别为(12.8±3.4)s和(9.6±3.8)s,双侧对比差异亦有统计学意义(t=7.104,P<0.01)。9例病灶<5 mm患者中,仅2例CT灌注为阳性,患侧及对侧局部灌注平均CBF分别为(448.0±137.8)ml.min-1.L-1和(422.2±229.6)ml.min-1.L-1,两者比较差异无统计学意义(t=0.664,P>0.5);患侧及对侧局部平均TTP分别为(10.1±2.0)s和(9.3±1.3),两侧之间差异无统计学意义(t=1.039,P>0.5)。结论CT脑灌注成像能为基底节区腔隙性脑梗死提供有价值的脑血流动力学信息,为临床超早期诊断和治疗提供依据。
Objective To investigate the value of CT perfusion imaging in lacunar infarction of basal ganglia. Materials and Methods 35 patients with ultra-early stage (onset <6 h) of basal ganglia lacunar infarction underwent routine CT skull imaging and CT cerebral perfusion imaging. At the level of basal ganglia after conventional axial CT scan, 45 ml of non-ionic contrast agent was injected through the elbow vein and continuous single-layer continuous dynamic scanning for 40 seconds was started. The reconstructed 40 dynamic images were performed using CT cerebral perfusion software Processing, get perfusion image. The regional cerebral blood flow (CBF) and the peak time of local perfusion (TTP) in the bilateral basal ganglia area of interest were measured and quantified. Results Totally 29 of 35 patients with lacunar infarction in basal ganglia were proved to be lacunar infarcts in the basal ganglia by follow-up CT or MRI. Among them, 20 cases of infarction diameter> 5 mm (<20 mm) and 9 cases Lesions <5 mm; more than 6 cases were negative CT review and clinical diagnosis of cerebral infarction. CT perfusion was positive in 17 out of 20 cases> 5 mm in diameter (<20 mm). The CBF was significantly lower than the normal side and TTP was significantly longer than the normal side. In the other 3 cases, no perfusion abnormalities were found. The average CBF of the ipsilateral and contralateral side of the 20 patients with infarct diameter> 5 mm (<20 mm) were (384.9 ± 118.7) ml.min-1.L-1 and (256.2 ± 80.3) ml.min- (T = 5.898, P <0.01). The mean TTP of the ipsilateral and contralateral sides were (12.8 ± 3.4) s and (9.6 ± 3.8) s, respectively, and the differences between the two groups were statistically significant There was also a statistically significant difference between the two groups (t = 7.104, P <0.01). Only 2 of 9 patients with lesions less than 5 mm had positive CT perfusion. The mean CBF of ipsilateral and contralateral perfusion were (448.0 ± 137.8) ml.min-1.L-1 and (422.2 ± 229.6) ml, respectively. min-1.L-1, the difference between the two groups was not statistically significant (t = 0.664, P> 0.5); the mean TTP of ipsilateral and contralateral were (10.1 ± 2.0) s and (9.3 ± 1.3) No significant difference between the sides (t = 1.039, P> 0.5). Conclusion CT perfusion imaging can provide valuable cerebral hemodynamics information for lacunar infarction in basal ganglia and provide basis for ultra-early diagnosis and treatment.