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目的:探讨64层螺旋CT脑CTP联合头颈CTA对缺血性脑卒中早期诊断的临床应用价值。方法:收集50例拟诊急性脑梗死患者,均于急性发作12 h内完成CTA及CTP检查,并及时行相关临床治疗,30 d后复查头颅CT或MRI平扫。结果梗死区CBF、CBV与对侧相应区差异有统计学意义(P<0.01),半暗带区CBF、TTP与对侧相应区差异有统计学意义(P<0.01),CBV差异无统计学意义(P>0.05)。CTP诊断半暗带,与复查结果比较,差异无统计学意义(P>0.05),敏感度为95%,特异性为69%;斑块最多见于颈动脉叉(21%)、颈内动脉颅内段(17%)及大脑中动脉(19%),52%为易损斑块。大脑前循环CTP异常同侧供血动脉的狭窄程度与对侧相比,差异有显著统计学意义(P=0.005),同侧供血动脉的斑块类型及易损斑块与对侧相比,差异有显著统计学意义(P<0.001)。结论:CTP能够快速直观区分梗死区与半暗带,以“CBV-TTP不匹配,且delay TTP>6 s”方法诊断半暗带准确性较高,大脑供血动脉中度以上狭窄、软斑块、混合斑块以及易损斑块等与脑缺血呈明显正相关,CTP联合CTA对急性脑卒中有很高应用价值。
Objective: To investigate the clinical value of 64-slice spiral CTP combined with CTA in the early diagnosis of ischemic stroke. Methods: Fifty patients with suspected acute cerebral infarction were enrolled. All patients underwent CTA and CTP within 12 hours after the onset of acute cerebral infarction. Relevant clinical treatments were performed in time. CT or MRI was performed after 30 days. Results The CBF and CBV in the infarct area were significantly different from those in the contralateral side (P <0.01). The CBF and TTP in the penumbra were significantly different from those in the contralateral side (P <0.01) Significance (P> 0.05). CTP diagnosis of penumbra, compared with the review results, the difference was not statistically significant (P> 0.05), the sensitivity was 95%, specificity 69%; plaque most common in carotid artery fork (21%), internal carotid artery Internal segment (17%) and middle cerebral artery (19%), 52% of vulnerable plaque. Compared with the contralateral side, there was significant difference in the contralateral CTP anomalous cerebral anterior cerebral artery stenosis (P = 0.005), the type of ipsilateral feeding artery plaque and the vulnerable plaque compared with the contralateral There was significant statistical significance (P <0.001). Conclusions: CTP can quickly distinguish the infarct zone from the penumbra quickly and accurately, with “CBV-TTP mismatch and delay TTP> 6s” method to diagnose the penumbra with high accuracy, moderate cerebral infarction, Plaque, mixed plaque and vulnerable plaque were positively correlated with cerebral ischemia. CTP combined with CTA had high value in acute stroke.