颈动脉双源CT血管造影和脑CT动态灌注成像在缺血性脑血管病的应用

目的运用颈动脉双源CT血管造影(CTA)和脑CT动态灌注成像(DCTPI)扫描,探讨缺血性脑血管病患者颈动脉粥样硬化斑块造成管腔狭窄与脑缺血之间的关系。方法临床诊断短暂性脑缺血发作和超急性或急性脑梗死患者40例,急诊行头颅CT或MRI扫描后,立即行颈动脉双源CTA和脑DCTPI扫描,对颈动脉粥样硬化斑块造成管腔的狭窄程度和脑灌注血流参数进行评价。结果 40例患者中,颈动脉无狭窄9例,占22.5%;轻度狭窄9例,占22.5%;中度狭窄12例,占30.0%;重度狭窄8例,占20.0%;完全闭塞2例,占5.0%。15例超急性或急性脑梗死患者梗死中心区患侧脑血流量较对侧明显下降,同时梗死中心区脑血流量较缺血半暗带或边缘区也明显下降,差异有统计学意义(P0.05);梗死中心区与缺血半暗带或边缘区脑血容量、造影剂到达峰值时间、平均通过时间差异无统计学意义(P0.05)。结论颈动脉双源CTA和脑DCTPI联合应用可同时显示颈动脉粥样硬化斑块造成颈动脉狭窄情况和缺血脑组织的部位和范围,为临床治疗缺血性脑血管病提供影像学依据。

Application of DSCTA of carotid artery and dynamic CT perfusion imaging of brain to assessing ischemic cerebrovascular disease

Objective To investigate the relation between the ischemic cerebrovascular disease and the grade of stenosis of carotid artery caused by carotid atherosclerotic plaque,and the diagnostic value of dynamic CT perfusion imaging(DCTPI) and dual-source CTA(DSCTA) for ischemic cerebrovascular disease.Methods Forty patients with ischemic cerebrovascular disease underwent DSCTA and DCTPI immediately after plain CT or MRI.The grade of stenosis of carotid artery was evaluated.With CT perfusion software,cerebral blood flow (CBF) ,cerebral blood volume (CBV) and time to peak(TTP) of contrast-medium enhancement within specific regions of the brain were measured.Results 9(22.5%) had normal carotid artery,9 (22.5%) had mild stenosis, 12(30.0%) had moderate stenosis,8 (20.0%) had severe stenosis and 2(5.0%) had occlusion. In the 15 patients with hyperacute or acute cerebral infarction,the mean values of CBF in the central area of infarct was significantly decreased compared with ischemic penumbra(IP) or marginal zone and contralateral side.CBV and TTP in central area of infarct,IP or marginal zone were normal or approximate normal.Conclusion DSCTA of carotid artery combined with DCTPI of brain are potentially useful to detecting the carotid stenosis and cerebral ischemic changes,which can provide valuable information for treatment of ischemic cerebrovascular disease.