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目的探讨76例急性缺血性脑血管病(AICVD)的多模式CT影像学特点。方法采用320排多层螺旋CT对76例AICVD(发病时间<24h)患者急诊进行CT平扫(NCCT)+CT灌注成像(CTP)+CT血管成像(CTA)一站式扫描检查,分析灌注区脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)等灌注参数变化及CT血管成像(CTA),并于入院后3d内行头颅MRI,评估其脑灌注特点及血管影像。结果在获取的76例CTP数据中,通过感兴趣区识别划分筛查,有59例患者有明确的异常CTP,有17例患者未发现明确感兴趣区。59例异常CTP中包括急性脑梗死47例,短暂性脑缺血发作(TIA)12例。急性脑梗死患者异常CTP特点:发病在4.5h以内的4例患者CTP表现为患侧CBF均较健侧下降,CBV正常或者轻度增高,MTT、TTP延长;发病时间在4.5~6h内的4例:其中2例CTP表现为CBF降低,CBV正常,MTT、TTP延长,2例表现为CBF降低,CBV轻度降低,MTT、TTP延长;发病时间在6~24h内的39例:其中30例梗死区与CTP异常脑灌注区部位一致,均表现CBF明显降低,CBV明显降低,MTT、TTP延长;12例TIA患者CTP均发现与临床症状相对应的灌注异常:MTT、TTP延长,CBF正常或减低,CBV升高。CTA发现责任动脉重度狭窄5例,血管闭塞10例,7例可见血流缓慢,排空延迟及侧支血管形成。结论多模式CT能够对AICVD提供血流灌注参数的变化及血管情况、供血区的血流动力学变化,对临床诊治具有一定参考价值,主要用于评估大脑半球卒中,多模式CT有临床价值。
Objective To investigate the multimodality CT features of 76 patients with acute ischemic cerebrovascular disease (AICVD). Methods A total of 76 patients with AICVD (onset time <24 h) were examined by CT scan (CTP) + CT angiography (CTA) with one-scan CT scan with 320-row multi-slice spiral CT. CBF, CBV, MTT, TTP and other CT perfusion parameters and CT angiography (CTA) were performed. Brain MRI was performed on the third day after admission Cerebral perfusion characteristics and vascular images. Results Of the 76 CTP data obtained, 59 patients had a clear abnormal CTP through the identification of regions of interest, and 17 patients did not find a clear region of interest. Fifty-nine cases of abnormal CTP included 47 cases of acute cerebral infarction and 12 cases of transient ischemic attack (TIA). Abnormal CTP characteristics in patients with acute cerebral infarction: 4 cases of onset within 4.5h CTP showed ipsilateral CBF compared with the contralateral fall, CBV normal or mildly elevated, MTT, TTP prolongation; onset time in 4.5 ~ 6h in 4 cases : 2 cases of CTP showed reduced CBF, CBV normal, MTT, TTP prolonged, 2 cases showed reduced CBF, CBV mildly reduced, MTT, TTP prolongation; onset time within 6 ~ 24h in 39 cases: 30 cases of infarction The areas of CTP abnormal brain perfusion were consistent with those of CTP. CBF was significantly decreased, CBV was significantly decreased and MTT and TTP were prolonged. The perfusion abnormalities corresponding to clinical symptoms were found in all 12 CTP patients: MTT, TTP prolongation, CBF normal or decreased , CBV increased. CTA found 5 cases of responsible arterial stenosis, vascular occlusion in 10 cases, 7 cases showed slow blood flow, emptying delay and collateral vessels. Conclusion Multimodality computed tomography (CT) can provide the parameters of blood perfusion to AICVD and the changes of blood vessels and hemodynamics of blood supply area. It has some reference value for clinical diagnosis and treatment. It is mainly used to evaluate cerebral hemispheric stroke and multimodal CT.