CT灌注成像对急性缺血性脑卒中半暗带的评估

©1994-2010ChinaAcademicJournalElectronicPublishingHouse.Allrightsreserved.(2010)0220135203CT,,,:2009211213;:2010201225:(RC2006XK004004):(,150001;,):CT(CTperfusionimaging,CTPI)16CT21CTPI,1wCTPI,(relativecerebralbloodflow,rCBF)(relativecerebralvolume,rCBV),CT,CBF,CBV,MTTrCBFrCBV(P0.05),;rCBF(P0.05)rCBV(P0.05),rCBF0.4250.582CTPI,:;;;X;;:R743.3:APenumbraassessmentofacutecerebralischemicinfarctionbyCTperfusionimagingYINFeng,QIShu2yi,ZHUJing,etal.(TheFirstSectionofCadre’sWard,theFirstAffiliatedHospitalofHarbinMedicalUniversity,Harbin150001,China)Abstract:ObjectiveToinvestigatetheappliedvalueofischemicpenumbrabyCTperfusionimaginginacutecere2bralinfarction.Methods21acutecerebralischemicpatientsunderwentCTPIscansimmediatelyafterplainCTscanswithvenousbolusinjectionofcontrast.Therelativeperfusionparameters(rCBFandrCBV)wereassessedsemiquantitativelybyusingtheresultsfrommirroredregionswithinthecontralateralhemisphereasreference.Andafteroneweek,theresultswereanalyzedbyreferringtothefollow2upCTPIscans.ResultsAllcases’ischemiclesionscanbefoundonCTPI,thelesionsshowedhypoperfusionandMTTdelay,CBFdecrease,andCBVdecreaselightly.ThetechniquesofCTperfusionimagingcouldnotonlylocatetheischemicfocusduringtheacutephase,butalsoquantitativelyevaluatetheabnormalhemodynamicsinthepreinfarctionperiodsanddifferentiatecerebralinfarctionfromischemicregion.Intheinfarctionregion,therewerenoobviouschangesofrCBFandrCBV(P0.05)afteroneweek,andthethresholdvaluesofrCBFandrCBVwereverylow.Respectively,inthepenumbra,rCBFwasincreasedobviouslyafteroneweekbutrCBVwasalmostnochanges.ConclusionThetechniquesofCTperfusionimagingcanquantitativelyevaluatetheinfarctregionandthepenumbra,anditcanprovidvaluableinformationtopredicttissueoutcome.Keywords:Cerebralischemia;Cerebralinfarction;Tomography;X2raycomputed;Perfusion;Penumbra,(ischemicpenumbra,IP),IP[1],CTPI,CT,11.120075200812CTPI21,2.520h8,13,4177,63.04:;,,BabinskiGordonHoffmann(+)CTCTPI,1wCTPI21,71.2CT:,53120102272©1994-2010ChinaAcademicJournalElectronicPublishingHouse.Allrightsreserved.:CT:80KV300mA6mm512512200mm200mm4s4.5ml/s,50ml300,1/s,40s,1601.3SIEMENSSyngoNavigator,perfusionCT/VA10B(cerebralbloodflowmap,CBF),(cerebralbloodvol2ume,CBV),(meantransittime,MTT)CTPI(),,,()5(regionofinterest,ROI),ROIrCBF(rCBF=/);rCBV(rCBV=/)1.4s,SPSS13.0t,P0.05,22.1CTCT,14(9h)CBF,CBV,MTT;CBF,CBV,MTT(1)2.2CT,,(2)CTrCBFrCBV(P0.05),,,;rCBF(P0.05),rCBV(P0.05),rCBF0.4250.582(12)1rCBF(s)P0.0370.0210.4670.0240.9630.0980.0130.0060.9520.0170.9870.035P0.05P0.05P0.05:=0.052rCBV(s)P0.0120.0060.8740.0410.9810.0520.0100.0020.9470.0330.9910.019P0.05P0.05P0.05:=0.053Hakim[2],,(NIH)t2PA3h,6h,,,:,,5ml/100gmin21,30min,10ml/100gmin21,2Heiss[3],,,,16h,48hHoffner[4],CBF1618ml/100gmin21Thijs[5],,,,,6h,,,,631JApoplexyandNervousDiseases,February2010,Vol27,No.2©1994-2010ChinaAcademicJournalElectronicPublishingHouse.Allrightsreserved.[6,7]CTPI,CBFCBVMTT,CBFCBVMTTCTPI,,CBF[8],rCBFKonig[9],CBF0.20,CBF0.200.35,,Konig[9]rCBF=0.29,14CTPI,36h,CTPI,6hrCBF0.4670.024,95%0.4250.582,,,,,CTPET,,CT,CTCTPICTCT,,,(6h),rCBF,,[][1]ProvenzaleJM,JahanR,NaidichTP,etal.Assessmentofthepatientwithhyperacutestroke:imagingandtherapy[J].Radiology,2003,229(2):3472359.[2]HakimAM.Ischemicpenumbra:thetherapeuticwindow[J].Neurol2ogy,1998,51(suppl3):5442546.[3]HeissWD.Ischemicpenumbra:evidencefromfunctionimaginginman[J].CerebBloodFlowMetab,2000,20(9):127621293.[4]HoffnerEG,CaseI,JainR,etal.CerebralperfusionCT:techniqueandclinicalapplications[J].Radiology,2004,231:6322644.[5]ThijsVN,AdamiA,Neumann2HaefelinT,etal.RelationshipbetweenseverityofMRperfusiondeficitandDWIlesionevolution[J].Neu2rology,2001,57:120521211.[6]KoenigM,KlotzE,LdkaB,etal.PerfusionCTofthebrain:diag2nositcapproachforearlydetectionischemicstroke[J].Radiology,1998,209(1):85293.[7],,.CT[J].,2007,24(6):6942696.[8]KloskaSP,NabaviDG,GausC,etal.AcutestrokeassessmentwithCT:doweneedmultimodalevaluation[J].Radiology,2004,233:79286.[9]KonigM.BrainperfusionCTinacutestroke:currentstatus[J].EurJRadiol,2003,45(Suppl1):11222.1CTPI2CBFaCBF;bCBV;cMTT,,73120102272