摘要:
目的:探讨64层螺旋CT脑CTP联合头颈CTA对缺血性脑卒中早期诊断的临床应用价值。方法:收集50例拟诊急性脑梗死患者,均于急性发作12 h内完成CTA及CTP检查,并及时行相关临床治疗,30 d后复查头颅CT或MRI平扫。结果梗死区CBF、CBV与对侧相应区差异有统计学意义(P<0.01),半暗带区CBF、TTP与对侧相应区差异有统计学意义(P<0.01),CBV差异无统计学意义(P>0.05)。CTP诊断半暗带,与复查结果比较,差异无统计学意义(P>0.05),敏感度为95%,特异性为69%;斑块最多见于颈动脉叉(21%)、颈内动脉颅内段(17%)及大脑中动脉(19%),52%为易损斑块。大脑前循环CTP异常同侧供血动脉的狭窄程度与对侧相比,差异有显著统计学意义(P=0.005),同侧供血动脉的斑块类型及易损斑块与对侧相比,差异有显著统计学意义(P<0.001)。结论:CTP能够快速直观区分梗死区与半暗带,以“CBV-TTP不匹配,且delay TTP>6 s”方法诊断半暗带准确性较高,大脑供血动脉中度以上狭窄、软斑块、混合斑块以及易损斑块等与脑缺血呈明显正相关,CTP联合CTA对急性脑卒中有很高应用价值。
Abstract:
Objective: To study the clinical applicative value of brain CT perfusion joint head and neck CT angiography with 64-slice multi-detectors CT for acute ischemic brain stroke. Methods: 50 cases of maybe acute cerebral infarction patients were collected to CTA and CTP examination within 12 hours after onset, and related clinical treatment in time. Head CT or MRI review were took 30 days later. Results: CBF, CBV of Infarct and contralateral corresponding area was significantly statistically different(P < 0.01), CBF, TTP of penumbra and contralateral corresponding area was significantly statistically different(P < 0.01), but CBV with no statistically significantly difference(P > 0.05). CTP diagnosis penumbra, compared with the results of the review, the difference was not statistically significant(P > 0.05), with a sensitivity of 95% and a specificity of 69%. Most plaque were found in the carotid bifurcation(21%), intracranial internal carotid artery(17%) and middle cerebral artery(19%), 52% of vulnerable plaque. Compared the stenosis between ipsilateral and contralateral feeding artery in patients with anterior circulation CTP abnormalities, the difference was statistically significant(P=0.005), the difference of plaque type and vulnerable plaque was statistically significant(P < 0.001). Conclusions: CTP can visually distinguish infarct and penumbra. Higher accuracy was found with method "CBV-TTP does not match, and delay TTP > 6 s" to diagnose penumbra, Moderate or more stenosis, soft plaques, mixed plaques and vulnerable plaques in feeding artery were positively correlated with stroke. CTP and CTA have a high application value for acute ischemic brain stroke.
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