吴菊芳　梁立华　陈志军　梁　韬　冯晓荣深圳市福田区人民医院影像科，广东深圳　518003

CT灌注成像联合头颈CTA对急性脑梗死的诊断价值

吴菊芳梁立华陈志军梁韬冯晓荣
深圳市福田区人民医院影像科，广东深圳518003

目的 探讨脑CT灌注（CTP）成像联合头颈CT血管成像（CT angiography，CTA）对急性缺血性脑卒中的诊断价值，为临床诊断、及时处理脑卒中患者提供可靠的依据。方法收集神经内科诊治急性脑梗死患者30例，所有患者均已完成64层CT平扫和CTA、CTP检查。30 d后复查头颅CT或MRI平扫。 结果 与对侧正常对照区相比，脑梗死区及缺血半暗带区CBF明显降低，MTT显著增加（P＜0.05）；脑梗死区CBV及CBF明显低于缺血半暗带区，MTT显著长于缺血半暗带区 （P＜0.05）；CTA共显示14例患者存在脑动脉局限性狭窄。结论CTP能够快速直观区分梗死区与半暗带区，对于较大的闭塞血管，CTA能找到梗死责任血管，为不能溶栓的患者介入治疗提供影像学依据。

脑梗死；急性期；脑灌注；体层摄影术；X线计算机

[Abstract]Objective To investigate the value of cerebral CT perfusion(CTP)imaging combined with CTA in the diagnosis of acute ischemic stroke,and to provide a reliable basis for clinical diagnosis and timely treatment of stroke patients.Methods Neurological department of internal medicine in the diagnosis and treatment of acute cerebral infarction in 30 cases,all patients had completed the 64-slice spiral CT scan,CTA,CTP examination.30 days later,the head CT or MRI scans were reviewed.Results Compared with the contralateral normal region,cerebral infarction and ischemia penumbra CBF decreased significantly,MTT was significantly increased(P<0.05);cerebral infarction area of CBV and CBF was lower than that in ischemia penumbra.MTT was significantly longer than that in the ischemic penumbra(P<0.05);CTA showed limitations of cerebral artery stenosis of 14 patients.Conclusion CTP can quickly and visually distinguish between infarct area and ischemic penumbra,for the larger occluded vessels,CTA can find the infarction responsible blood vessels,which can provide imaging evidence for patients who can not be treated with thrombolysis.

[Key words]Cerebral infarction;Acute phase;Cerebral perfusion;Tomography;X-ray computer

缺血性脑卒中（ischemic stroke）是临床多发病、常见病，其致死率及致残率极高，如何及时溶栓抢救缺血半暗带脑组织，一直是困扰临床医生的难题。MRI灌注成像及功能成像被认为是判断梗死区及缺血半暗带的标准[1]，但其普及率及检查较多禁忌证（相对CT）限制了其使用，同时检查时间较长，急性脑梗死患者较难配合。而CT灌注成像（CT perfusion imaging，CTP）作为一种安全、快速、多参数的检查方法，成为近年来研究的热点，本文旨在探索CTP对急性缺血脑卒中诊断的价值，联合CT血管造影（CTA，CT angiography）检查，能否做到一次检查获得全面的急性脑梗死的相关信息。……