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目的探讨CT平扫联合CT灌注成像(CTP)、CT血管造影(CTA)在早期缺血性脑血管病(CVD)中的应用价值。方法对45例发病24 h内临床诊断为短暂性脑缺血发作(TIA)或脑梗死(CI)的CVD患者,同时行CT平扫、CTP、CTA检查,CI患者在发病后2～7d行头颅CT复查,对比头颅CT复查所见梗死区及脑灌注血流图缺血区,确定缺血半暗带,所有患者作灌注参数及CTA结果分析。结果 (1)10例TIA患者CT平扫未见异常,CTP表现为与临床症状相对应的灌注异常区达峰值时间(TTP)延长,CTA显示7例血管狭窄;(2)35例CI患者中,CT平扫见低密度灶5例,未见异常30例。发病在6 h内的22例患者中有19例存在缺血半暗带;发病6～24 h的13例患者中2例存在缺血半暗带,梗死区的脑血流量、脑血容量及半暗带区的脑血流量与对侧比较差异均有统计学意义(均P<0.05),而半暗带区的脑血容量与对侧比较差异无统计学意义(P>0.05)。本组35例CTA显示有26例患者存在颈内动脉、大脑中动脉或大脑后动脉不同程度的狭窄或完全闭塞。结论 CT平扫、CTP、CTA三项联合检查对发病24h内的CVD患者,能够鉴别TIA及CI、预测CI患者是否存在缺血半暗带、评价大血管情况,为实现溶栓的个体化治疗提供重要依据。
Objective To investigate the value of CT combined with CT perfusion imaging (CTP) and CT angiography (CTA) in early ischemic cerebrovascular disease (CVD). Methods Forty-five patients with CVD diagnosed as transient ischemic attack (TIA) or cerebral infarction (CI) within 24 hours of onset were examined by CT scan, CTP and CTA at the same time. The CI patients were examined at 2 to 7 days after onset CT craniocerebral recanalization of cerebral infarction compared with cerebral infarction and perfusion perfusion map of the ischemic area to determine the ischemic penumbra, perfusion parameters for all patients and CTA results analysis. Results (1) CT scan of 10 cases of TIA patients showed no abnormalities, CTP showed prolonged peak time (TTP) of perfusion abnormalities corresponding to clinical symptoms, and CTA showed 7 cases of vascular stenosis; (2) Among 35 CI patients CT scan showed low density lesions in 5 cases, no abnormalities in 30 cases. In the 6 h, 22 of 19 patients had ischemic penumbra; 2 of 13 patients with 6-24 h onset had ischemic penumbra, cerebral blood flow in cerebral infarction area, cerebral blood volume and The cerebral blood flow in the penumbra area was significantly different from the contralateral (all P <0.05), while there was no significant difference in cerebral blood volume between the penumbra and the contralateral (P> 0.05). The group of 35 CTAs showed that there were 26 patients with varying degree of stenosis or complete occlusion of the internal carotid artery, middle cerebral artery or posterior cerebral artery. Conclusion CT scan, CTP, CTA three joint examination within 24 hours of onset of CVD patients, can identify TIA and CI, predict the presence of ischemic penumbra CI patients, evaluation of macrovascular conditions, in order to achieve the thrombolytic individualized treatment Provide important basis.