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目的 评价CT灌注成像(CT perfusion imaging,CTP)联合CT血管成像(CT angiography,CTA)对发病12 h内缺血性脑卒中的临床价值.方法 对15例发病时间在12h内的脑卒中患者同时行CT平扫、CTP、CTA检查,将CTP图像通过图像工作站(Syng.VIA)经过VPCT Neuro-STROKE进行处理,测量缺血区的脑灌注参数值并分析缺血半暗带(ischemicpenumbra,IP);通过CT血管减影(CT-DSA)模式获取头颅及颈部脑血管图像,并分析CTA结果.结果 15例患者中7例患者头颅CT出现早期低密度病灶,其余8例未见明显异常;发病在4.5 h之内的患者有6例,其中有5例患者经CTP显示存在缺血半暗带,另外1例患者CTP显示未见缺血半暗带,经随访证实为短暂性脑缺血发作(TIA);发病在4.5～6 h的患者有2例,其中有1例患者经CTP显示存在缺血半暗带,另外1例不存在;发病在6～12h的患者有7例,其中仅有1例经CTP显示存在缺血半暗带,其余不存在缺血半暗带.在经CTP显示存在缺血半暗带的7例患者中,梗死区的脑血流量(CBF)、脑血容量(cBV)、平均通过时间(MTT)较对侧差异均有统计学意义(P＜0.05);缺血半暗带区的CBF、MTT较对侧差异有统计学意义(P＜0.05),CBV较对侧差异无统计学意义(P＞0.05);缺血半暗带区的CBF、CBV及MTT较梗死区差异有统计学意义(P＜0.05).CTA显示有14例患者存在颈内动脉(ICA)或大脑中动脉(MCA)不同程度的狭窄或完全闭塞.结论 CTP联合CTA对急性缺血性脑梗死患者的诊断和治疗具有指导意义,并通过CTP判定是否存在缺血半暗带可以指导急性缺血性脑卒中的个体化治疗.“,”Objective To evaluate the clinical value of CT perfusion imaging and CT angiography in diagnosis and treatment of acute ischemia stroke within 12 hours.Methods Within 12 hours after the onset of acute ischemia stroke on 15 patients with CT scan,CTP and CTA examination,measurement of the ischemic region of the brain perfusion parameter values analysis of the ischemic penumbra by VPCT Neuro-STROKE of Syng.VIA;analysis of the CT angiography that is obtained by the model of CT-DSA.Results 7 cases of cranial CT scan revealed signs of early cerebral infraction in 15 patients,the others are normal.5 of the patients within 4.5 hours have ischemic penumbra,the CTP of the other one is normal and the patient has transient ischemic attacks (TIA) who is confirmed by the follow-up visit;One of the patients within 4.5 ～ 6 hours has ischemic penumbra by CTP,the other one has not;One of the patients within 6 ～ 12 hours has ischemic penumbra by CTP,the others have not.7 patients with CTP were detected in the cerebral infraction in cerebral blood flow,cerebral blood volume,mean peak time and on the side of the difference was significant (P ＜ 0.05);The penumbra zone in cerebral blood flow,mean peak time and contralateral differences was significant (P ＜ 0.05);Cerebral blood volume showed no significant difference (P ＞ 0.05).The penumbra zone in cerebral blood flow,cerebral blood volume,mean peak time and the cerebral infraction of the difference was significant (P ＜ 0.05).CTA showed that 14 patients have the vascular occlusion or angiostenosis in different degrees in internal carotid artery and middle cerebral artery.Conclusion CTP and CTA has a guiding significance in the diagnosis and therapy of acute ischemia stroke.It can help to make individual therapy for acute ischemic stroke by evaluating the ischemic penumbra using CTP.