Evaluated value of CT perfusion imaging on cerebral tissue blood perfusion, cerebral collateral blood circulation status and responsible vessel stenosis in patients with acute ischemic stroke
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摘要:
目的 探究CT灌注成像(CTPI)对急性缺血性脑卒中患者脑组织血流灌注情况、脑侧支血流循环状态及责任血管狭窄的评估价值。 方法 选取攀枝花市中西医结合医院2021年3月~2022年3月收治的51例急性缺血性脑卒中患者，入院后行CT平扫及CT灌注成像。分析患者不同区域脑血流量(CBF)、脑血容量(CBV)、对比剂平均通过时间(MTT)、对比剂峰值时间(TTP)，比较不同侧支血流循环状态CTPI参数情况及责任血管不同狭窄程度。 结果 CTPI显示，46例脑组织血流灌注发生异常，CTPI阳性率为90.20%(46/51)。患者患侧梗死病灶区及缺血半暗带CBF值、CBV值均小于健侧，MTT值、TTP值均长于健侧(P < 0.05)。侧支循环良好者患侧CBF值小于健侧，MTT值及TTP值均长于健侧(P < 0.05)，而患侧与健侧CBV值比较差异无统计学意义(P > 0.05);侧支循环不良者患侧CBF值及CBV值均小于健侧，且MTT值及TTP值均长于健侧(P < 0.05)。CTPI提示AIS脑组织血流灌注异常患者责任血管重度狭窄或闭塞发生率高于CTPI提示血流灌注正常患者(P < 0.05)。 结论 CTPI可及时准确反映急性缺血性脑卒中患者梗死病灶区、缺血半暗带血流灌注情况，有助于临床掌握患者侧支循环状态，对责任血管狭窄程度进行客观评估。 Abstract:Objective To explore the evaluated value of CT perfusion imaging (CTPI) on cerebral tissue blood perfusion, cerebral collateral blood circulation status and responsible vessel stenosis in patients with acute ischemic stroke. Methods Fifty- one patients with acute ischemic stroke who were treated in Panzhihua Hospital of Integrated Traditional Chinese and Western Medicine were selected from March 2021 to March 2022, and they underwent CT plain scan and CT perfusion imaging after admission. The cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and time to peak (TTP) in different regions of patients were analyzed. CTPI parameters in different collateral blood circulation status and different stenosis degrees of responsible vessels were compared. Results CTPI of patients with AIS showed abnormal cerebral tissue blood perfusion in 46 cases, with the positive rate of CTPI was 90.20% (46/51). The CBF and CBV of the infarcted lesion area and ischemic penumbra of the affected side were lower than those of the healthy side. The MTT and TTP were longer than those of the healthy side (P < 0.05). Among patients with good collateral circulation, the CBF value of the affected side was lower than that of the healthy side, and the MTT and TTP were longer than those of the healthy side (P < 0.05). But there was no statistical significance in CBV between the affected side and the healthy side (P > 0.05). The CBF and CBV of the affected side in patients with poor collateral circulation were lower than those of the healthy side, and the MTT and TTP were longer than those of the healthy side (P < 0.05). The incidence rate of severe stenosis or occlusion of responsible vessels in patients with abnormal cerebral tissue blood perfusion indicated by CTPI was higher than that in patients with normal blood perfusion indicated by CTPI (P < 0.05). Conclusion CTPI can timely and accurately reflect the blood perfusion in the infarcted lesion area and ischemic penumbra in patients with acute ischemic stroke. It is helpful for clinically grasping the collateral circulation status, objectively assessing the responsible vessel stenosis degree. -
图 3 AIS患者脑部CTP成像
A: L-MCA供血区CBV较对侧略增加; B: L-MCA供血区CBF较对侧降低; C: L-MCA供血区TTP较对侧延长; D: L-MCA供血区MTT较对侧延长.
Figure 3. CTP imaging of patients withAIS.
表 1 CTPI阳性患者患侧梗死病灶区与健侧相应区域CTPI参数比较
Table 1. Comparison of CTPI parameters between the infarcted lesion area of the affected side and the corresponding area of the healthy side in CTPI-positive patients (n=46, Mean±SD)
部位 CBF[mL/(100 g·min)] CBV(mL/100 g) MTT(s) TTP(s) 患侧 23.25±3.46 2.09±0.53 6.03±0.97 16.24±2.08 健侧 45.83±6.59 2.74±0.62 3.39±0.52 12.16±1.47 t 20.575 5.405 16.269 10.864 P < 0.001 < 0.001 < 0.001 < 0.001 CBF: 脑血流量; CBV: 脑血容量; MTT: 平均通过时间; TTP: 峰值时间. 
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表 2 CTPI阳性患者患侧缺血半暗带与健侧相应区域CTPI参数比较
Table 2. Comparison of CTPI parameters between the ischemic penumbra of the affected side and the corresponding area of the healthy side in CTPI-positive patients (n=46, Mean±SD)
部位 CBF[mL/(100 g·min)] CBV(mL/100g) MTT(s) TTP(s) 患侧 32.76±3.15 2.29±0.43 5.74±0.84 15.37±2.43 健侧 47.07±6.84 2.87±0.65 3.48±0.69 11.75±1.56 t 12.888 5.047 11.854 8.502 P < 0.001 < 0.001 < 0.001 < 0.001
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表 3 侧支循环良好者梗死病灶区与健侧CTPI参数比较
Table 3. Comparison of CTPI parameters between infarcted lesion area and healthy side in patients with good collateral circulation (n=20, Mean±SD)
部位 CBF[mL/(100 g·min)] CBV(mL/100 g) MTT(s) TTP(s) 患侧 25.45±1.06 2.49±0.11 5.76±0.31 15.43±1.16 健侧 46.07±5.19 2.62±0.33 3.32±0.37 11.96±1.07 t 17.408 1.671 22.606 12.242 P < 0.001 0.103 < 0.001 < 0.001
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表 4 侧支循环不良者患侧梗死病灶区CTPI参数比较
Table 4. Comparison of CTPI parameters between infarcted lesion area and healthy side in patients with poor collateral circulation (n=31, Mean±SD)
部位 CBF[mL/(100 g·min)] CBV(mL/100 g) MTT(s) TTP(s) 患侧 22.74±2.54 1.97±0.28 6.13±0.52 16.58±1.42 健侧 44.12±3.96 2.89±0.36 3.59±0.24 12.36±1.03 t 25.303 11.231 24.693 13.394 P < 0.001 < 0.001 < 0.001 < 0.001
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表 5 责任血管不同狭窄程度患者CTPI血流灌注情况比较
Table 5. Comparison of CTPI blood perfusion status in patients with different stenosis degrees of responsible vessels [n(%)]
CTPI血流灌注情况 责任血管狭窄程度 轻度狭窄 中度狭窄 重度狭窄或闭塞 血流灌注异常(n=46) 8(63.64) 20(95.45) 18(100.00) 血流灌注正常(n=5) 3(36.36) 2(4.55) 0(0) Z 2.260 P 0.024 CTPI: CT灌注成像.
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