[1]侯朝华,侯艳红,侯华森.CT灌注源图像在诊断超急性期缺血性脑卒中的应用价值[J].国际放射医学核医学杂志,2010,34(2):125-129.[doi:10.3760/cma.j.issn.1673-4114.2010.02.019]
　HOU Zhao-huo,HOU Yan-hong,HOU Hua-sen.Diagnostic value of perfusion source images in hyperacute stroke[J].International Journal of Radiation Medicine and Nuclear Medicine,2010,34(2):125-129.[doi:10.3760/cma.j.issn.1673-4114.2010.02.019]
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《国际放射医学核医学杂志》[ISSN:1673-4114/CN:12-1381/R]

卷:
34
期数:
2010年第2期
页码:
125-129
栏目:
临床放射医学
出版日期:
1900-01-01

文章信息/Info

Title:
Diagnostic value of perfusion source images in hyperacute stroke
作者:
侯朝华;  侯艳红;  侯华森
天津市大港油田总医院放射科, 300280
Author(s):
HOU Zhao-huo;  HOU Yan-hong;  HOU Hua-sen
Department of Radiology, Tianjin Dagang Oil Field Hospital, Tianjin 300280, China
关键词:
脑血管意外; 脑缺血; 体层摄影术; X线计算机; 灌注
Keywords:
Cerebrovascular accident; Brain ischemia; Tomography; X-ray computed; Perfusion
DOI:
10.3760/cma.j.issn.1673-4114.2010.02.019
摘要:
目的 探讨CT灌注源图像(CTPSI)在超急性期缺血性脑卒中诊断中的临床应用价值。方法 100例急性缺血性脑卒中(发病时间<9 h)的患者行"一站式"CT检查,根据动脉期与静脉期CTPSI Alberta卒中早期CT评分(ASPECTS)的不同将100例患者分为2组:有延迟灌注组和无延迟灌注组。分析基线平扫CT、动脉期及静脉期CTPSI ASPECTS,并与随访影像AS-PECTS进行对照。Wilcoxon秩和检验比较动脉期CTPSI与静脉期CTPSI ASPECTS之间的统计学差异;应用多元线性回归分析基线"一站式"CT各个影像学形态ASPECTS与随访影像ASPECTS之间的线性依存关系。结果 100例患者分为有延迟灌注组42例和无延迟灌注组58例。基线平扫CT、动脉期、静脉期和随访影像的ASPECTS中位数(最小值~最大值)在有延迟灌注组分别为:8.0(6.0~10.0)、7.0(1.0~8.0)、8.0(3.0~10.0)、7.5(0~10.0);在无延迟灌注组分别为:8.0(1.0~10.0)、7.5(1.0~10.0)、8.5(1.0~10.0)、7.0(0~10.0)。在无延迟灌注组,动脉期与静脉期CTPSI ASPECTS差异无统计学意义(Z=-1.00,P=0.459),而在有延迟灌注组,两者差异有统计学意义(Z=-3.08,P=0.001).在无延迟灌注组,基线影像ASPECTS(平扫CT、动脉期及静脉期CTPSI)与随访影像AS-PECTS均存在正相关(r值分别为0.879、0.902、0.945,P值均<0.01);在有延迟灌注组,静脉期CTPSI与随访影像ASPECTS的相关性最好(r=0.831,P=0.004)。多元线性回归结果显示只有静脉期CTPSI与随访影像ASPECTS之间的线性关系有统计学意义:无延迟灌注组,标准化回归系数β=0.946,P<0.001;有延迟灌注组,β=0.714,P=0.003。结论 CTPSI显示无延迟灌注者不存在缺血半暗带,提示不适合溶栓治疗;有延迟灌注者提示存在缺血半暗带,是溶栓治疗的重要依据之一。
Abstract:
Objective To investigate the diagnostic value of CT perfusion source images(CTPSI) in acute stroke less than 9 hours. Methods "One-stop shop" CT examination were performed in 100 patients with symptoms of acute stroke in less than 9 hours. Patients were divided into two groups according to with and with-out delayed perfusion on CTPSI, and compared Alberta stroke program early CT score study(ASPECTS) scores on non-contrast CT, arterial phase CTPSI and venous phase CTPSI with follow-up imaging. The ASPECTS were analyzed on arterial phase CTPSI and venous phase CTPSI using Wilcoxon rank-sum test, then compared with the follow up imaging ASPECTS using multiple linear regressions. Resulte The median(min-max) scores of ASPECTS on NCCT, arterial phase CTPSI, venous phase CTPSI and follow-up imaging were 8.0(6.0-10.0), 7.0(1.0-8.0), 8.0(3.0-10.0) and 7.5(0-10.0) in group with delayed perfusion, respectively, and 8.0(1.0-10.0), 7.5(1.0-10.0), 8.5(1.0-10.0) and 7.0(0-10.0) in group without delayed perfusion respectively. ASPECTS scores measured on arterial phase CTPSI did not differ with venous phase CTPSI group without delayed perfusion(Z=-1.001 P=0.459), while there was statistic difference in group with delayed perfusion(Z=-3.08, P=0.00l).There were significant correlation of ASPECTS scores measured on mon-contrast CT, arterial phase CTPSI and venous phase CTPSI to follow-up imaging ASPECTS(r=0.879, 0.902, 0.945, P<0.01) in group without delayed perfusion; ASPECTS measured in venous phase CTPSI showed the best correlation to follow-up imaging ASPECTS(r=0.831, P=0.004) in group with delayed perfusion. Multiple linear regression showed that the correlation in only venous phase CTPSI with follow-up imaging ASPECTS was statistically significant:in group without delayed perfusion, β=0.946, P<0.001; in group with delayed perfusion, β=0.714, P=0.003. Conclusion Presence of delayed perfusion in CTPSI is quit important in identifying ischemic penumbra, which plays a critical role in imaging-guided thrombolytic therapy.

参考文献/References:

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[2] Wintermark M,Meuli R,Browaeys P,et al.Comparison of CT perfusion and angiography and MRI in selecting stroke patients for acute treatment.Neurology,2007,68(9):694-697.
[3] Wintermark M,Flanders AE,Velthuis B,et al.Peifusion-CT assessment of infarct core and penumbr a:receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke.Stroke,2006,37(4):979-985.
[4] Ezzeddine MA,Lev M H,McDonald CT,et al.CT angiography with whole brain perfused blood volume imaging:added clinical value in the assessment of acute stroke.Stroke,2002,33(4):959-966.
[5] González RG.Imaging-guided acute ischemic stroke therapy:From "time is brain" to "physiology is brain".AJNR Am J Neuroradiol,2006,27(4):728-735.
[6] Murphy BD,Fox AJ,Lee DH,et al.Identification of penumbra and infarct in acute ischemic stroke using computed tomography perfusion-derived blood flow and blood volume measurements.Stroke,2006,37(7):1771-1777.
[7] Hill MD,Rowley HA,Adler F,et al.Selection of acute ischemic stroke patients for intra-arterial thrombolysis with pro-urokinase by using ASPECTS.Stroke,2003,34(8):1925~1931.
[8] Pexman JH,Barber PA,Hill MD,et al.Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke.AJNR Am J Neuroradiol,2001,22(8):1534-1542.
[9] Pepper EM,Parsons MW,Bateman GA,et al.CT perfusion source images improve identification of early ischaemic change in hyperacute stroke.J Clin Neurosci,2006,13(2):199-205.
[10] Parsons MW,Pepper EM,Bateman GA,et al.Identification of the penumbra and infarct core on hyperacute noncontrast and perfusion CT.Neurology,2007,68(10):730-736.

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备注/Memo

备注/Memo:
收稿日期:2009-11-25。
更新日期/Last Update: 1900-01-01