CAJ | 학술논문

目的探讨CT灌注成像(CTP)对短暂性脑缺血发作(TIA)患者发作间期的应用价值.方法对自2011年10月1日至2012年12月30日在唐山市工人医院神经内科住院的69例TIA患者在其发作间期行CTP检查,获得脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)等参数.根据CTP结果对TIA患者进行分期,并分析脑灌注异常与患者临床表现的关系.结果 69例TIA患者中有52例出现与临床表现相一致的脑灌注异常.根据CTP图CBF的改变情况分为Ⅰ期TIA 25例、Ⅱ期TIA 27例.Ⅰ期TIA患者患侧与健侧TTP 、MTT比较差异有统计学意义(P＜0.05),CBF、CBV比较差异无统计学意义(P＞0.05);Ⅱ期TIA患者患侧与健侧TTP、MTT、CBF比较差异有统计学意义(P＜0.05),CBV比较差异无统计学意义(P＞0.05).Ⅱ期TIA患者中TIA发作时美国国立卫生研究院卒中量表评分(NIHSS)≥4分者比例(68.2％)及发作持续时间≥60 min者比例(75.0％)均明显高于Ⅰ期患者(31.8％、25％),差异均有统计学意义(P＜0.05).52例脑灌注异常的TIA患者中,NIHSS评分及TIA发作持续时间均与患侧CBF/健侧CBF的比值呈负相关(r=-0.548,P=0.000;r=-0.848,P=0.000),与患侧TTP/健侧TTP的比值呈正相关(r=0.732,P=0.000;r=0.927,P=0.000),与患侧MTT/健侧MTT的比值呈正相关(r=0.668,P=0.000;r=0.902,P=0.000).结论 CTP能够显示TIA患者发作间期的脑灌注异常,且与患者的临床表现相关,其可为TIA的诊断、治疗提供进一步的影像学依据.
목적 탐토CT관주성상(CTP)대단잠성뇌결혈발작(TIA)환자발작간기적응용개치.방법 대자2011년10월1일지2012년12월30일재당산시공인의원신경내과주원적69례TIA환자재기발작간기행CTP검사,획득뇌혈류량(CBF)、뇌혈용량(CBV)、평균통과시간(MTT)、체봉시간(TTP)등삼수.근거CTP결과대TIA환자진행분기,병분석뇌관주이상여환자림상표현적관계.결과 69례TIA환자중유52례출현여림상표현상일치적뇌관주이상.근거CTP도CBF적개변정황분위Ⅰ기TIA 25례、Ⅱ기TIA 27례.Ⅰ기TIA환자환측여건측TTP 、MTT비교차이유통계학의의(P＜0.05),CBF、CBV비교차이무통계학의의(P＞0.05);Ⅱ기TIA환자환측여건측TTP、MTT、CBF비교차이유통계학의의(P＜0.05),CBV비교차이무통계학의의(P＞0.05).Ⅱ기TIA환자중TIA발작시미국국립위생연구원졸중량표평분(NIHSS)≥4분자비례(68.2％)급발작지속시간≥60 min자비례(75.0％)균명현고우Ⅰ기환자(31.8％、25％),차이균유통계학의의(P＜0.05).52례뇌관주이상적TIA환자중,NIHSS평분급TIA발작지속시간균여환측CBF/건측CBF적비치정부상관(r=-0.548,P=0.000;r=-0.848,P=0.000),여환측TTP/건측TTP적비치정정상관(r=0.732,P=0.000;r=0.927,P=0.000),여환측MTT/건측MTT적비치정정상관(r=0.668,P=0.000;r=0.902,P=0.000).결론 CTP능구현시TIA환자발작간기적뇌관주이상,차여환자적림상표현상관,기가위TIA적진단、치료제공진일보적영상학의거.
Objective To explore the value of CT perfusion (CTP) at the interphase in patients with transient ischemic attack (TIA) by applying 16 multi-slice spiral CT.Methods Sixty-nine TIA patients,admitted to our hospital from October 1,2011 to December 30,2012,were performed CTP;cerebral blood flow (CBF),cerebral blood volume (CBV),mean transit time (MTT) and time to peak (TTP) were measured within specific regions of the brains.Staging was performed according to the CTP results;the relationship between abnormal CTP and clinical symptoms of TIA patients was analyzed.Results In 69 patients with TIA,persisting abnormal perfusion changes corresponding to clinical symptoms were found in 52 patients.According to the CTP results,stage Ⅰ TIA included 25 patients and stage Ⅱ included 27 patients;the TTP and MTT in stage Ⅰ patients were significantly different between the affected side and the contralateral side (P＜0.05),while the CBF and CBV showed no significant difference (P＞0.05);the TTP,MTT and CBF in stage Ⅱ patients were significantly different between the affected side and the contralateral side (P＜0.05),while CBV showed no significant difference (P＞0.05).The percentages of stage Ⅱ patients with National Institutes of Health Stroke Scale (NIHSS) scores higher or equal to 4 points (68.2％) and onset duration longer than 60 min during TIA (75.0％) were significantly higher than those of stage Ⅰ patients (31.8％,25％,P＜0.05).NIHSS scores and duration of TIA onset were negatively correlated with the CBF ratio (affected/contralateral side;r=-0.548,P=0.000;r=-0.848,P=0.000),positively correlated with the TTP ratio (affected/contralateral side;r=0.732,P=0.000;r=0.927,P=0.000),and positively correlated with the MTT ratio (affected/contralateral side;r=0.668,P=0.000;r=0.902,P=0.000) in 52 TIA patients.Conclusion CTP provides valuable hemodynamic information,which could be used as the imaging basis of TIA diagnosis and treatment.