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目的探讨多层螺旋CT动态4D扫描用于急性脑梗死患者rt-PA静脉溶栓前后脑部血流灌注及病灶血管成像的临床价值。方法回顾性分析2013年2月—2015年2月收治的急性脑梗死行rt-PA静脉溶栓治疗患者共62例多层螺旋CT动态4D扫描资料,比较治疗前后病灶边缘区局部脑血流量(r CBF)、局部脑血容量(r CBV)、达峰时间(TPP)及平均通过时间(MTT)。结果全部62例患者rt-PA静脉溶栓前,55例局部动脉血管分支减少,7例脑血管成像未见明显异常;rt-PA静脉溶栓后60例梗死区局部血管分支增多,2例脑血管成像未见明显异常。急性脑梗死患者rt-PA静脉溶栓前r CBF、r CBV、TPP及MTT水平分别为(20.73±5.44)、(1.21±0.30)、(19.37±3.70)、(6.52±0.77);静脉溶栓后r CBF、r CBV、TPP及MTT水平分别为(37.66±8.10)、(1.96±0.41)、(18.98±4.25)、(6.55±0.81);静脉溶栓后r CBF和r CBV水平显著优于静脉溶栓前,差异有统计学意义(P<0.05);急性脑梗死患者rt-PA静脉溶栓前后TTP和MTT水平比较差异无统计学意义(P>0.05)。结论多层螺旋CT动态4D扫描可准确反映急性脑梗死患者rt-PA静脉溶栓前后脑部血流灌注及病灶血管情况,可为溶栓疗效评价提供可靠依据。
Objective To investigate the clinical value of multi-slice spiral CT dynamic 4D scanning in cerebral perfusion and focal vascular imaging before and after rt-PA thrombolysis in patients with acute cerebral infarction. Methods The data of 62 cases of multi-slice CT dynamic 4D scanning in patients with acute cerebral infarction treated with intravenous thrombolytic therapy of rt-PA from February 2013 to February 2015 were analyzed retrospectively. The regional cerebral blood flow r CBF, r CBV, time to peak (TPP) and mean transit time (MTT). Results Before the rt-PA thrombolysis in all 62 patients, the local arterial branches were reduced in 55 cases and no abnormalities were found in 7 cases. In the 60 cases of rt-PA thrombolytic therapy, No obvious abnormality of angiography. The levels of r CBF, r CBV, TPP and MTT before rt-PA thrombolysis in patients with acute cerebral infarction were (20.73 ± 5.44), (1.21 ± 0.30), (19.37 ± 3.70) and (6.52 ± 0.77), respectively; The levels of r CBF, r CBV, TPP and MTT were (37.66 ± 8.10), (1.96 ± 0.41), (18.98 ± 4.25) and (6.55 ± 0.81) after intravenous thrombolysis Before intravenous thrombolysis, the difference was statistically significant (P <0.05). The levels of TTP and MTT before and after intravenous thrombolysis in patients with acute cerebral infarction had no significant difference (P> 0.05). Conclusions Multi-slice spiral CT dynamic 4D scan can accurately reflect the cerebral blood flow perfusion and vascular lesions before and after rt-PA thrombolysis in patients with acute cerebral infarction, which can provide a reliable basis for the evaluation of thrombolytic efficacy.