螺旋CT一站式检查对缺血性脑卒中的诊断价值

目的探讨16排螺旋CT灌注成像联合血管成像对缺血性脑卒中的诊断价值。方法使用西门予16排螺旋CT对40例临床诊断为缺血性脑卒中患者行NNCT＋CTP＋CTA检查，所有患者入院24h内完成该“一站式”检查。经西门子后处理软件进行评估。结果灌注异常区的CBF（t=2．45）、CBV（t=3．07）、MTT（t=2．89）三组参数值与对侧相比差异有统计学意义（P〈0．05）；颈内动脉狭窄12处：中度狭窄4处，重度狭窄及闭塞8处；颅内动脉狭窄25处：中度8处，重度狭窄及闭塞17处。颈内动脉及颅内动脉均狭窄6例。灌注异常区的灌注参数仅MTT值异常与颈内动脉狭窄程度具有低的正相关性，Pearson相关系数r值=0．523〉0．5，P=0．012。供血动脉狭窄程度与脑组织缺血程度不成正比。结论“一站式”CT检查能灵敏而准确地反映脑组织血流动力学变化及有效地判断头颈动脉系统是否存在狭窄和闭塞、确定病变部位和测量狭窄程度。

Combined Application of CT Perfusion and CT Angiography in Diagnosis of Cerebral Ischemic Stroke

Objective To investigate the value of 16-slices spiral CT perfusion（CTP） combined with CT angiography（CTA） in the diagnosis of cerebral ischemic stroke. Methods The non contrast（NNCT） ,CT perfusion imaging（CTP） and CT angiography （CTA） were performed by using 16-slices spiral CT（Siemens Company） in 40 patients diagnosed as ischemic stroke in clinic. All patients received the ＂one-stop＂ check in 24 hours after admission. The information was analyzed with Siemens post-processing software. Results The cerebral blood flow（CBF） ,cerebral blood volume（CBV） and mean transit time（MTT） of the abnormal perfusion regions were significantly different from the parameters of the contralateral regions （ t = 2.45,3.07 and 2.87, respectively,P 〈 0.05）. There were 12 cases with internal carotid artery Stenosis （moderately narrow 4 cases, severe stricture and block 8 cases） ;25 cases with intracranial artery stenosis（ moderately narrow 8 cases, severe stricture occlusion 17 cases） ;6 cases with both intracranial and internal carotid artery stenosis. Only MTF value of the abnormal perfusion region had a weak correlation with the degree of internal carotid artery stenosis,Pearson correlation coefficient was 0. 523（r 〉0.5 ,P =0.012）. The degree of brain ischemia was no correlated to the degree of carotid stenosis. Conclusion The ＂one-stop＂ CT can accurately and sensitively reflect the hemodynamic changes in brain, and can effectively be used to judge the existence of stenosis or occlusion in neck artery system, determine the lesion site and measure the degree of stenosis.