急性脑梗死患者血管异常与CT灌注成像及临床预后关系的研究

首都医科大学学报 ›› 2010, Vol. 31 ›› Issue (2): 149-153.

急性脑梗死患者血管异常与CT灌注成像及临床预后关系的研究

马青峰¹, 贾建平^1*, 薛素芳¹, 黄小钦¹, 于跃怡¹, 卢洁², 张苗²

1. 首都医科大学宣武医院神经内科;2. 首都医科大学宣武医院放射科

收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2010-04-21 发布日期:2010-04-21
通讯作者: 贾建平

Relationship among Vessel Abnormalities, Computed Tomographic Perfusion Imaging and Prognosis in Hyperacute Cerebral Infarction

MA Qing-feng¹, JIA Jian-ping^1*, XUE Su-fang¹, HUANG Xiao-qin¹, YU Yue-yi¹, LU Jie², ZHANG Miao²

1. Department of Neurology, Xuanwu Hospital, Capital Medical University; 2. Department of Radiology, Xuanwu Hospital, Capital Medical University

Received:1900-01-01 Revised:1900-01-01 Online:2010-04-21 Published:2010-04-21
Contact: JIA Jian-ping

摘要/Abstract

摘要： 目的探讨急性脑梗死患者脑血管异常与CT灌注成像（computed tomographic perfusion，CTP）参数的关系，以及对临床预后的影响。方法对75例发病6 h内的颈内动脉系统急性脑梗死患者进行CT平扫、CTP及CT血管造影（CT angiography，CTA）检查，记录CTP各参数，同时评价病灶侧大血管情况；分别在发病时、发病第14天、发病第90天采用美国国立卫生研究院卒中量表（national institute of health stroke scale，NIHSS）、Barthel 指数 (Barthel index，BI)、改良的Rankin量表（modified rankin scale，mRS）评价临床神经功能缺损、日常生活能力及预后功能残疾水平。结果 ① 75例患者CTA检查显示血管大致正常29例，大脑中动脉狭窄11例，大脑中动脉闭塞13例，颈内动脉狭窄6例，颈内动脉闭塞16例。② 病灶侧血管狭窄组与血管闭塞组及血管正常组比较，患者缺血区脑血流（cerebral blood flow，CBF）异常面积、脑血容量（cerebral blood volume，CBV）异常面积、局部灌注达峰时间（time to peak，TTP）异常面积、梗死区相对CBF (relative CBF，rCBF)及相对CBV(relative CBV，rCBV)差异有统计学意义（P<0.05）；其中血管闭塞组CTP的脑灌注参数异常改变均比血管正常组明显，且差异有统计学意义；血管狭窄组CTP的脑灌注参数仅CBF面积比血管正常组增加，且差异有统计学意义；血管闭塞组CTP的脑灌注异常范围（CBF面积、TTP面积、CBV面积）均明显大于血管狭窄组（P<0.05）。③ 患者发病时仅NIHSS评分在3组之间比较差异有统计学意义，血管正常组明显优于血管狭窄组和血管异常组；在发病第14天、发病第90天的NIHSS、BI、mRS评分在3组之间比较差异均有统计学意义（P<0.05），其中血管正常组各项评分均明显优于血管闭塞组患者（P<0.05）。结论急性脑梗死患者病灶侧血管异常与CTP显示的缺血范围相关，并且可以作为患者临床预后的评价指标。

关键词: 急性脑梗死, CT灌注成像, 脑血管闭塞, 预后

Abstract: Objective To investigate the relationship between vessel abnormality and computed tomographic(CT) perfusion imaging(CTP) as well as the role of vessel abnormality in evaluating prognosis of patients with hyperacute cerebral infarction. Methods Nonenhancement CT, CTP and CTA were performed on 75 patients with acute internal carotid system cerebral infarction within 6 hours of symptom onset. Large vessel stenosis or occlusions on infarction side were assessed. National Institute of Health Stroke Scale score(NIHSS), Barthel Index(BI) and modified Rankin Scale(mRS) were used as evaluation index for neurological function impairment and extent of disability in prognosis. These scores were assessed on the same day, 14th and 90th days after stroke onset respectively. Results ① Of these 75 patients, 29 had normal vessel, 11 had middle cerebral artery stenosis, 13 patients with middle cerebral artery occlusion, 6 had internal carotid artery stenosis, and 16 had internal carotid occlusion. ② There were significant differences among groups of occlusion, stenosis and normal vessels in terms of cerebral blood flow(CBF) area, cerebral blood volume(CBV) area, time to peak(TTP) area, relative CBF(rCBF) and relative CBV(rCBV), CTP parameters of vessel occlusion were significantly different from those of normal vessels. Only CBF area of vessel stenosis group significantly increased compared with normal vessels. The areas of CTPabnormalities(area of CBF, CBV and TTP) of vessel occlusion were significantly greater than those of vessel stenosis(P<0.05). ③ Only the NIHSS was significantly different among three groups at the onset day, patients with normal cerebral arteries have better value than patients with vessel stenosis or occlusion. NIHSS, BI and mRS were all different among the three groups at 14th and 90th days after stroke onset respectively, patients with normal cerebral arteries had better values than patients with vessel occlusion(P<0.05). Conclusion The vessel abnormalities on infarction side in patients with acute cerebral infarction is associated with ischemic areas in indicated by CTP parameters and can be used as an evaluation index for clinical prognosis.

Key words: acute cerebral infarction, CT perfusion imaging, cerebral artery occlusion, prognosis

中图分类号:

R 743

马青峰;贾建平;薛素芳;黄小钦;于跃怡;卢洁;张苗. 急性脑梗死患者血管异常与CT灌注成像及临床预后关系的研究[J]. 首都医科大学学报, 2010, 31(2): 149-153.

MA Qing-feng;JIA Jian-ping;XUE Su-fang;HUANG Xiao-qin;YU Yue-yi;LU Jie;ZHANG Miao. Relationship among Vessel Abnormalities, Computed Tomographic Perfusion Imaging and Prognosis in Hyperacute Cerebral Infarction[J]. Journal of Capital Medical University, 2010, 31(2): 149-153.

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