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目的:探讨短暂性脑缺血发作(TIA)患者颈动脉狭窄及斑块性质与脑卒中危险性的关系。材料与方法:对26例临床诊断为TIA的病人行头颅CT平扫,脑CT灌注和颈动脉血管成像。评价脑CT灌注成像的峰值时间(TTP),脑血流量(CBF),脑血容量(CBV)等脑血流动力学改变,以及颈动脉的狭窄程度及斑块的性质。结果:26例TIA患者中,CTA显示颈动脉狭窄19例,轻度7例(37%),中度8例(42%),重度4例(21%);发现颈动脉斑块44处,其中混合性斑块9处,钙化性斑块22处,纤维性斑块7处,脂质性斑块6处。老年组钙化性斑块明显高于中青年组,P<0.05,有显著性差异。在26例TIA患者中,21例头颅CT平扫正常,5例有腔隙性脑梗塞,其中多发2例。26例脑CTP检查,异常17例,正常9例,17例脑CTP异常患者患侧与对侧的平均TTP分别为(11.25±1.94)s和(8.64±0.96)s,经配对t检验:t=9.418,P<0.01,两者间差异有非常显著性意义;两侧平均CBF、平均CBV均无统计学意义。随访6个月中3例发生脑梗塞。结论:TIA患者颈内动脉狭窄与脑卒中的发生密切相关。CT脑灌注成像结合CTA,不仅可以发现颈动脉有无狭窄及斑块的性质,还可以了解脑组织的血流动力学改变和脑组织的损害情况,具有较高的临床应用价值。
Objective: To investigate the relationship between carotid stenosis and plaque characteristics and the risk of stroke in patients with transient ischemic attack (TIA). Materials and Methods: Twenty-six patients diagnosed as TIA underwent CT scan, brain CT perfusion and carotid artery imaging. To evaluate cerebral hemodynamic changes such as peak time (TTP), cerebral blood flow (CBF), cerebral blood volume (CBV) in cerebral CT perfusion imaging, as well as the degree of carotid stenosis and plaque properties. Results: Among 26 TIA patients, CTA showed 19 cases of carotid stenosis, 7 cases were mild (37%), 8 cases were moderate (42%) and 4 cases was severe (21%). There were 9 mixed plaques, 22 calcified plaques, 7 fibrous plaques and 6 lipid plaques. Elderly calcification plaques were significantly higher than the young group, P <0.05, there were significant differences. Of 26 TIA patients, 21 had normal CT scans and 5 had lacunar infarcts, of which 2 were multiple. The mean TTP of ipsilateral and contralateral in 17 patients with abnormal brain CTP were (11.25 ± 1.94) s and (8.64 ± 0.96) s respectively in 26 cases of brain CTP examination, 17 cases of abnormality and 9 cases of normal. The paired t-test: t = 9.418, P <0.01, the difference between the two groups has a very significant significance; mean CBF on both sides, mean CBV were not statistically significant. Three cases were followed up for 6 months. Conclusion: The internal carotid artery stenosis in TIA patients is closely related to the occurrence of stroke. CT perfusion imaging combined with CTA, not only can be found in the carotid stenosis and the nature of the plaque, but also to understand the brain tissue hemodynamic changes and brain damage, with high clinical value.