当代医学
噹代醫學
당대의학
CHINA CONTEMPORARY MEDICINE
2015年
5期
4-7
,共4页
64层螺旋CT%CT灌注成像%CT血管成像%脑梗死
64層螺鏇CT%CT灌註成像%CT血管成像%腦梗死
64층라선CT%CT관주성상%CT혈관성상%뇌경사
64-slice CT%CT perfusion imaging%CT angiography%Acute cerebral infarction
目的：（1）以脑CTP发现急性脑梗死的脑灌注特点；（2）以头颈CTA分析患者头颈血管狭窄程度及斑块特点。方法收集拟诊急性脑梗死患者行CTP联合CTA检查，测量梗死核心、半暗带区以及对侧相应区的CBF、CBV及TTP等参数值，并计算rCBF、rCBV及delayTTP值，评价各参数敏感性。以“CBV－TTP不匹配，且delayTTP＞6s”方法来判断半暗带，评价CTP的诊断价值。以CTA分析头颈血管狭窄程度及斑块的特征。比较颈动脉分叉与颈内动脉颅内段狭窄程度与斑块类型的差异。结果（1）梗死区CBF[(8.79±8.23)mL/（100g·min）]，CBV[(0.97±0.73)mL/100g]均明显减低；半暗带区CBF[(32.13±12.10)mL/（100g·min）]轻度减低，TTP[(15.90±3.59)s]明显延迟，CBV[(2.49±0.7)mL/100g]不变或稍增高。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；（2）CTP诊断半暗带，与复查结果比较，差异无统计学意义，敏感度为95%，特异性为69%；（3）斑块最多见于颈动脉分叉（21%）、颈内动脉颅内段（17%）及大脑中动脉（19%），52%为易损斑块。颈动脉分叉以轻度狭窄为主（67%），混合斑块较多（61%），颈内动脉颅内段以钙化斑块为主（76%），但差异无统计学意义。结论64层螺旋CT头颈CTA及脑CTP联合应用可发现头颈动脉狭窄、斑块特征和脑血流动力学改变情况，对急性脑梗死的早期诊断有很高的价值，有利于指导临床的早期干预治疗。
目的：（1）以腦CTP髮現急性腦梗死的腦灌註特點；（2）以頭頸CTA分析患者頭頸血管狹窄程度及斑塊特點。方法收集擬診急性腦梗死患者行CTP聯閤CTA檢查，測量梗死覈心、半暗帶區以及對側相應區的CBF、CBV及TTP等參數值，併計算rCBF、rCBV及delayTTP值，評價各參數敏感性。以“CBV－TTP不匹配，且delayTTP＞6s”方法來判斷半暗帶，評價CTP的診斷價值。以CTA分析頭頸血管狹窄程度及斑塊的特徵。比較頸動脈分扠與頸內動脈顱內段狹窄程度與斑塊類型的差異。結果（1）梗死區CBF[(8.79±8.23)mL/（100g·min）]，CBV[(0.97±0.73)mL/100g]均明顯減低；半暗帶區CBF[(32.13±12.10)mL/（100g·min）]輕度減低，TTP[(15.90±3.59)s]明顯延遲，CBV[(2.49±0.7)mL/100g]不變或稍增高。梗死區CBF、CBV與對側相應區差異有統計學意義（P＜0.01），半暗帶區CBF、TTP與對側相應區差異有統計學意義（P＜0.01），CBV差異無統計學意義；（2）CTP診斷半暗帶，與複查結果比較，差異無統計學意義，敏感度為95%，特異性為69%；（3）斑塊最多見于頸動脈分扠（21%）、頸內動脈顱內段（17%）及大腦中動脈（19%），52%為易損斑塊。頸動脈分扠以輕度狹窄為主（67%），混閤斑塊較多（61%），頸內動脈顱內段以鈣化斑塊為主（76%），但差異無統計學意義。結論64層螺鏇CT頭頸CTA及腦CTP聯閤應用可髮現頭頸動脈狹窄、斑塊特徵和腦血流動力學改變情況，對急性腦梗死的早期診斷有很高的價值，有利于指導臨床的早期榦預治療。
목적：（1）이뇌CTP발현급성뇌경사적뇌관주특점；（2）이두경CTA분석환자두경혈관협착정도급반괴특점。방법수집의진급성뇌경사환자행CTP연합CTA검사，측량경사핵심、반암대구이급대측상응구적CBF、CBV급TTP등삼수치，병계산rCBF、rCBV급delayTTP치，평개각삼수민감성。이“CBV－TTP불필배，차delayTTP＞6s”방법래판단반암대，평개CTP적진단개치。이CTA분석두경혈관협착정도급반괴적특정。비교경동맥분차여경내동맥로내단협착정도여반괴류형적차이。결과（1）경사구CBF[(8.79±8.23)mL/（100g·min）]，CBV[(0.97±0.73)mL/100g]균명현감저；반암대구CBF[(32.13±12.10)mL/（100g·min）]경도감저，TTP[(15.90±3.59)s]명현연지，CBV[(2.49±0.7)mL/100g]불변혹초증고。경사구CBF、CBV여대측상응구차이유통계학의의（P＜0.01），반암대구CBF、TTP여대측상응구차이유통계학의의（P＜0.01），CBV차이무통계학의의；（2）CTP진단반암대，여복사결과비교，차이무통계학의의，민감도위95%，특이성위69%；（3）반괴최다견우경동맥분차（21%）、경내동맥로내단（17%）급대뇌중동맥（19%），52%위역손반괴。경동맥분차이경도협착위주（67%），혼합반괴교다（61%），경내동맥로내단이개화반괴위주（76%），단차이무통계학의의。결론64층라선CT두경CTA급뇌CTP연합응용가발현두경동맥협착、반괴특정화뇌혈류동역학개변정황，대급성뇌경사적조기진단유흔고적개치，유리우지도림상적조기간예치료。
Objective (1)To explore the feature of CT perfusion in acute cerebral infarction; (2)To analyse artery stenosis and plauque characteristic with head and neck CT angiography in acute cerebral infarction.Methods Collected patients suspected with acute cerebral infarction, then underwent CTA and CTP, CBF, CBV, and TTP in infarct core, penumbra and contralateral areas were measured, and then calculated into rCBF, rCBV and delayTTP. The sensitivity of the parameters were evaluated. To defind the CTP value with "CBV-TTP mismatch, and delayTTP> 6s". Analyze the degree of stenosis and plaque characteristics in head and neck vessels with CTA. Compared differences on stenosis and plaque type between the carotid bifurcation and intracranial internal carotid artery.Results 1. infarct CBF [(8.79±8.23)mL/(100g?min)], CBV [(0.97±0.73) mL/100g] were significantly lower; penumbra CBF [(32.13±12.10)mL/(100g?min)] reduced slightly, TTP [(15.90±3.59)s] was significantly delayed, CBV [(2.49±0.7)mL/100g] unchanged or slightly increased. 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; (2)CTP diagnosis penumbra, compared with the results of the review, the difference was not statistically significant, with a sensitivity of 95% and a specificity of 69%; (3)Most plaque were found in the carotid bifurcation (21%), intracranial internal carotid artery (17%) and middle cerebral artery (19%), 52% of vulnerable plaque. Mainly mild stenosis (67%) and more mixed plaque (61%) were found in carotid bifurcations, compared with intracranial internal carotid artery with more calcified plaque (76%), the difference was not statistically significant (P=0.05).Conclusion CT perfusion and CT angiography with 64-slice multi-ditector CT mayfind the degree of cranial-neck stenosis and plaque characteristics and the change of cerebral hemodynamics, so it has a high value for diagnosis of acute cerebral infarction, could help guide clinical early intervention.
