低剂量全脑CTP在急性脑梗死疗效评估中的价值

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摘要目的：探讨128层螺旋CT行70 kV、100 mAs低剂量全脑CT灌注成像（CTP）在急性脑梗死疗效评估中的价值。资料与方法：选取23例发病＜24 h的急性脑梗死患者行头颅CT平扫及低剂量全脑CTP检查。7例行急诊静脉溶栓治疗，16例行常规药物对症支持治疗。治疗后7~10 d用相同扫描方案复查。对治疗前后病变中央区及边缘区相对脑血流量（rCBF）、相对脑血容量（rCBV）、相对达峰时间（rTTP）和相对平均通过时间（rMTT）进行分析比较。结果：急诊低剂量全脑CTP均发现与临床症状相对应的异常低灌注区。治疗后7~10 d复查，21例低灌注区范围较治疗前缩小，2例范围扩大。静脉溶栓患者治疗后病灶中央区rCBF与治疗前比较差异有统计学意义（P<0.05），rCBV与治疗前比较差异无统计学意义（P>0.05）；常规药物治疗患者治疗后病灶中央区rCBF、rCBV与治疗前比较差异无统计学意义（P>0.05）。静脉溶栓及常规药物治疗后病灶边缘区rCBF、rTTP、rMTT与治疗前比较差异有统计学意义（P<0.05），rCBV差异无统计学意义（P>0.05）。结论：低剂量全脑CTP在明显降低有效辐射剂量的同时，能早期诊断急性脑梗死，且能观察治疗前后脑血流动力学改变，结合头颅CT平扫及CTA，为临床评估急性脑梗死疗效提供全面影像学依据。

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	朱杰1
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	宋彬1
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	翁迎峰1

关键词 ：脑梗塞, 血栓溶解疗法, 体层摄影术, 螺旋计算机

Abstract：Objective: To explore the value of 128-slice spiral CT low doses whole-brain CT perfusion imaging(CTP) with 70 kV, 100 mAs in evaluating the treatment response of acute cerebral infarction. Methods: Conventional cerebral CT scanning and the low dose whole-brain CTP were performed on 23 patients with acute cerebral infarction within 24 hours. Seven patients underwent emergency intravenous thrombolysis treatment, and 16 patients underwent routine drug treatment. All patients were reexamined by the same schedule after 7~10 days’ treatment, the cerebral perfusion parameters of central and edge region, including the relative cerebral blood flow(rCBF), relative cerebral blood volume(rCBV), relative time to peak(rTTP) and relative mean transit time(rMTT), were compared before and after treatment. Results: Abnormal low perfusion changes corresponding to clinical symptoms were found in all 23 patients by emergency low doses whole-brain CTP. After 7~10 days’ treatment, the low dose whole-brain CTP showed that the ranges of low perfusion in 21 patients were narrowed, and 2 cases were expanded after treatment. After intravenous thrombolysis treatment, there was statistically significant difference in rCBF of the ischemic central region before and after treatment(P<0.05), and there was no statistically significant difference in rCBV(P>0.05). After routine drug treatment, there was no statistically significant difference in rCBF and rCBV of the ischemic central region(P>0.05). After both intravenous thrombolysis treatment and routine drug treatment, statistically significant differences were found in rCBF, rTTP and rMTT of the ischemic marginal region(P<0.05). No significant difference was detected in rCBV of the ischemic marginal region(P>0.05). Conclusion: The low doses whole-brain CTP could significantly reduce the effective radiation dose, meanwhile, it could not only diagnose acute cerebral infarction but also observe the cerebral hemodynamic changes before and after treatment, combining with routine CT scan and CTA, which provide comprehensive imaging basis for evaluating the therapeutic effect of acute cerebral infarction.

Key words： Brain infarction Thrombolytic therapy Tomography, spiral computed

收稿日期: 2016-07-27

PACS:	Ｒ743.33
	Ｒ814.42

基金资助:上海市闵行区卫生和计划生育委员会科研课题（编号2015MW10）。

通讯作者: 宋彬，上海市闵行区中心医院放射科，201199。E-mail：sb72778@189.cn

作者简介: 朱杰（1982-），男，上海人，主治医师。E-mail：zhujie_1982@163.com

引用本文:

朱杰1，张蓓2，宋彬1，魏冉1，翁迎峰1. 低剂量全脑CTP在急性脑梗死疗效评估中的价值[J]. 中国临床医学影像杂志, 2017, 28(3): 157-161.
ZHU Jie1, ZHANG Bei2, SONG Bin1, WEI Ran1, WENG Ying-feng1. The value of low doses whole-brain CTP in acute cerebral infarction curative effect evaluation. JOURNAL OF CHINA MEDICAL IMAGING, 2017, 28(3): 157-161.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2017/V28/I3/157

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