CT灌注成像在后循环超急性脑梗死中的应用价值

Le-Jun Fu, Bi-Bo Zhao, Tian-hao Yang, Chunshun Yu
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Results: The CTP results revealed that CBF and\n CBV in the infarction area significantly decreased, and MTT and TTP in the blood supply area of cerebellum, thalamus and posterior cerebral artery (PCA) were significantly delayed. These were statistically different from those in the surrounding penumbra and normal brain tissue (P <\n 0.05). Furthermore, the CBF of the penumbra in each part slightly decreased, and the delay of MTT and TTP was statistically different from that in normal brains (P < 0.05). The CBV of the penumbra in the pons, midbrain and thalamus decreased, which was statistically different from\n that in normal brain tissue and simple cerebral ischemia tissue (P < 0.05). The changes in CBF and MTT of the simple cerebral ischemia in each part, and TTP, except for the cerebellum, were statistically different from those of cerebral infarction and normal brain tissue (P\n < 0.05). 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摘要

目的:探讨后循环脑梗死超急性期ct灌注成像(CTP)的应用价值。方法:分析168例疑似后循环急性缺血性脑卒中患者CTP参数的变化,如到达峰值时间(TTP)、平均转运时间(MTT)、脑血流(CBF)、脑血容量(CBV)以及患侧缺血半暗带、梗死核心和未损伤侧正常脑组织。评价CTP各参数图显示后循环各部位脑梗死大小的敏感性、特异性、准确性、阳性预测值和阴性预测值。结果:CTP结果显示梗死区CBF、CBV明显降低,小脑、丘脑、大脑后动脉(PCA)血供区MTT、TTP明显延迟。与周围半暗带及正常脑组织比较,差异有统计学意义(P < 0.05)。各部位半暗带CBF均略有下降,MTT、TTP延迟较正常脑有统计学差异(P < 0.05)。脑桥、中脑和丘脑半暗带CBV下降,与正常脑组织和单纯脑缺血组织CBV下降差异有统计学意义(P < 0.05)。单纯性脑缺血各部位CBF、MTT及TTP的变化,除小脑外,与脑梗死及正常脑组织差异均有统计学意义(P < 0.05)。CTP评价后循环脑梗死的总敏感性、特异性和准确性分别为77.2%、98.6%和94.9%。结论:CTP参数图可以反映后循环缺血半暗带与梗死核区的差异。CTP评价脑后循环梗死具有较高的敏感性、特异性和准确性。
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Application Value of CT Perfusion Imaging in Patients with Posterior Circulation Hyperacute Cerebral Infarction
Objectives: This study aims to evaluate the application value of computed tomography perfusion (CTP) imaging in patients with posterior circulation cerebral infarction in the hyperacute phase. Methods: The changes in CTP parameters, such as time to peak (TTP), mean transfer time (MTT), cerebral blood flow (CBF) and the cerebral blood volume (CBV) of ischemic region, as well as the ischemic penumbra, infarction core at the affected side and normal brain tissue at the uninjured side, of 168 patients with suspected posterior circulation acute ischemic stroke were analyzed. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of each parameter map of CTP in displaying the cerebral infarction size in each part of the posterior circulation were evaluated. Results: The CTP results revealed that CBF and CBV in the infarction area significantly decreased, and MTT and TTP in the blood supply area of cerebellum, thalamus and posterior cerebral artery (PCA) were significantly delayed. These were statistically different from those in the surrounding penumbra and normal brain tissue (P < 0.05). Furthermore, the CBF of the penumbra in each part slightly decreased, and the delay of MTT and TTP was statistically different from that in normal brains (P < 0.05). The CBV of the penumbra in the pons, midbrain and thalamus decreased, which was statistically different from that in normal brain tissue and simple cerebral ischemia tissue (P < 0.05). The changes in CBF and MTT of the simple cerebral ischemia in each part, and TTP, except for the cerebellum, were statistically different from those of cerebral infarction and normal brain tissue (P < 0.05). The total sensitivity, specificity and accuracy for the posterior circulation cerebral infarction was 77.2%, 98.6% and 94.9%, respectively, according to the CTP evaluation. Conclusion: The CTP parameter map can reflect the difference between an ischemic penumbra and an infraction core in the posterior circulation. It has high sensitivity, specificity and accuracy in the CTP evaluation of posterior circulation cerebral infarctions.
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