CAJ | 학술논문

目的：探讨64排螺旋 CT 脑灌注成像（CT perfusion imaging，CTP）对早期脑梗死的诊断价值。方法：临床拟诊早期脑梗死患者38例，均在症状出现24 h 内行头颅 CT 平扫及 CTP 检查。将脑梗死核心区、缺血半暗带（ischemic penumbra，IP）区与健侧对应区的情况做对比分析。结果：38例患者中，15例头颅 CT 平扫发现可疑脑梗死区，主要位于大脑半球，表现为密度轻度减低、局部脑沟稍变浅等；其余23例患者 CT 平扫未发现异常。38例患者的 CTP 检查均发现灌注异常区，表现为脑梗死区脑血流量（cerebral blood flow，CBF）与脑血容量（cerebral blood volume，CBV）均较健侧对应区明显下降，对比剂平均通过时间（mean transit time，MTT）较健侧对应区缩短，对比剂达峰时间（time to peak，TTP）较健侧对应区明显延长，差异均有统计学意义（P ＜0．01）。早期脑梗死患者 IP 区与梗死核心区比较，CBF、CBV、MTT 及 TTP 差异均有统计学意义（P ＜0．01）；IP区与健侧对应区比较，CBF、MTT、TTP 差异均有统计学意义（P ＜0．05、0．01），CBV 差异无统计学意义（P ＞0．05）。获得随访的18例患者中，经积极溶栓等治疗后梗死区缩小6例，梗死区消失5例，仅表现为梗死区 TTP 和 MTT 延长、CBF 和 CBV 变化不大3例，梗死区无明显变化4例。结论：64排螺旋 CTP 检查可以准确地提示早期脑梗死。
목적：탐토64배라선 CT 뇌관주성상（CT perfusion imaging，CTP）대조기뇌경사적진단개치。방법：림상의진조기뇌경사환자38례，균재증상출현24 h 내행두로 CT 평소급 CTP 검사。장뇌경사핵심구、결혈반암대（ischemic penumbra，IP）구여건측대응구적정황주대비분석。결과：38례환자중，15례두로 CT 평소발현가의뇌경사구，주요위우대뇌반구，표현위밀도경도감저、국부뇌구초변천등；기여23례환자 CT 평소미발현이상。38례환자적 CTP 검사균발현관주이상구，표현위뇌경사구뇌혈류량（cerebral blood flow，CBF）여뇌혈용량（cerebral blood volume，CBV）균교건측대응구명현하강，대비제평균통과시간（mean transit time，MTT）교건측대응구축단，대비제체봉시간（time to peak，TTP）교건측대응구명현연장，차이균유통계학의의（P ＜0．01）。조기뇌경사환자 IP 구여경사핵심구비교，CBF、CBV、MTT 급 TTP 차이균유통계학의의（P ＜0．01）；IP구여건측대응구비교，CBF、MTT、TTP 차이균유통계학의의（P ＜0．05、0．01），CBV 차이무통계학의의（P ＞0．05）。획득수방적18례환자중，경적겁용전등치료후경사구축소6례，경사구소실5례，부표현위경사구 TTP 화 MTT 연장、CBF 화 CBV 변화불대3례，경사구무명현변화4례。결론：64배라선 CTP 검사가이준학지제시조기뇌경사。
Objective:To explore the diagnostic value of CT perfusion imaging(CTP)with 64 multi-detector spiral CT in early cerebral infarction.Methods:A total of 38 patients with suspected early cerebral infarction underwent plain CT and CTP within 24 h after the onset of related symptoms.The imaging results in infarction core area,ischemic penumbra (IP) and the contralateral normal region were comparatively analyzed.Results:Early cerebral infarction,mainly in cerebral hemispheres, were suspected in 15 patients of the total 38 patients with plain CT.The performance was light reduction of lesion density and slightly shallowing in local sulci.The plain CT results in the other 23 patients didn’t showed abnormal performance.Abnormal perfusion area were found in all 38 patients with CTP.Comparing with that in contralateral normal region,the imaging results in abnormal perfusion area showed significant decline of cerebral blood flow(CBF)and cerebral blood volume(CBV),shortening of mean transit time(MTT)and significant extension of time to peak(TTP).All the differences showed statistical significant differences(P <0.01).There were significant differences in CBF,CBV,MTT,TTP between the infarction core area and IP(P <0.01).And there were significant differences in CBF,MTT,TTP(P <0.05 and 0.01)between IP and the contralateral normal region while there was none in CBV(P >0.05).Among the 38 cases,18 patients were followed up after active thrombolytic therapy.Infarction area reduced in 6 patients and disappeared in 5 patients.Three cases showed only extension of TTP and MTT and little change of CBF and CBV.Four cases had no changes in infarction area.Conclusions:CTP with 64 multi-detector spiral CT can accurately prompt the diagnosis of early cerebral infarction.