| 高艳,李坤成,杜祥颖,刘佳宾,杨延辉.64排螺旋CT脑灌注和CT血管成像在大脑中动脉狭窄或闭塞的应用[J].中国医学影像技术,2006,22(8):1155~1158 |
| 64排螺旋CT脑灌注和CT血管成像在大脑中动脉狭窄或闭塞的应用 |
| Study on middle cerebral artery stenosis or occlusion by CT perfusion and CT angiography with 64-detector row CT |
| 投稿时间：2006-04-27 修订日期：2006-08-05 |
| DOI： |
| 中文关键词: 大脑中动脉 狭窄 闭塞 CT灌注 CT血管成像 |
| 英文关键词:Middle cerebral artery Stenosis Occlusion CT perfusion CT angiography |
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| 中文摘要: |
| 目的 评价64排螺旋CT脑灌注(CTP)联合头颈部CT血管成像(CTA)检查对大脑中动脉(MCA)狭窄或闭塞所致脑缺血的临床应用价值。方法 对37例经DSA诊断为单、双侧MCA狭窄或闭塞患者及10名正常成年志愿者分别进行螺旋CT头颅平扫、CTP和CTA检查。脑CTP检查获得脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TP)等参数值,判断脑缺血。结果 按照脑CTP的MTT和TP图将脑灌注延迟表现分为三型:Ⅰ型病变仅累及MCA区,Ⅱ型病变仅累及分水岭区,Ⅲ型病变同时累及MCA和分水岭区。①在25例单侧MCA狭窄/闭塞患者中,4例CTP正常,17例脑CTP灌注延迟区为Ⅰ型,4例为Ⅲ型。②与正常对照组相比,12例双侧大脑中动脉重度狭窄患者的双侧MCA支配区均有MTT和TP延迟,CBF下降和症状侧CBV升高的异常改变,提示为双侧脑缺血。侧支循环能明显减少单侧MCA狭窄患者的症状侧的脑灌注损伤,但对双侧MCA重度狭窄和闭塞患者,无论有无侧支循环,双侧脑组织灌注损伤都很严重。结论 脑CTP检查的MTT和TP图能敏感显示MCA重度狭窄或闭塞所致的脑灌注损伤,为脑缺血的诊断、治疗及预防脑梗死均具有重要价值。 |
| 英文摘要: |
| Objective To evaluate the application value of combining cerebral CT perfusion (CTP) with CT angiography (CTA) of 64-detector row CT (MDCT) in cerebral ischemia caused by stenosis or occlusion of middle cerebral artery (MCA). Methods Thirty-seven patients with unilateral or bilateral stenosis or occlusion of MCA diagnosed by DSA and 10 normal adult volunteers were scanned by CT, and the unenhanced axial CT, CTP and CTA were performed. To discriminate the ischemic focus, the parameter maps of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and time to peak (TP) were obtained. Results According to MTT and TP maps of CTP, the cerebral perfusion delay was divided into three types: type Ⅰ, the lesion only involved the MCA territory; type Ⅱ, the lesion only involved the boundary zone; and type Ⅲ, the lesion involved the both MCA territory and boundary zone. In 25 patients with unilateral stenosis or occlusion of MCA, 4 patients of CTP were normal, the type Ⅰ cerebral perfusion delay was depicted on CTP maps in 17 cases, and the type Ⅲ cerebral perfusion delay was seen in 4 cases. Comparing with normal control group, there were MTT and TP delay, CBF decrease and CBV increase in bilateral MCA territory in 12 cases with severe stenosis of bilateral MCA. These changes indicated the bilateral ischemia of brain. The collateral circulation could decrease the damage of symptomatic side of cerebral perfusion in the cases with unilateral stenosis of MCA, but no matter with or without collateral circulation, bilateral brain damage were also severe for the patents with significant stenosis and occlusion of bilateral MCA. Conclusion MTT and TP were sensitive to depict the perfusion damage of brain caused by MCA severe stenosis or occlusion, and play an important role in diagnosis, treatment of cerebral ischemia, and prevention of cerebral infarct. |
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