早期脑缺血非增强CT检查在预测缺血核及半暗带中作用.doc

早期脑缺血非增强CT检查在预测缺血核及半暗带中作用摘要： 目的：探讨早期脑缺血病变在非增强CT扫描的成像表现。方法：采用回顾性分析的 方法，对21例发病时间小于24h，临床怀疑有早期脑缺血，经过CT灌注扫描、CT和MRI随 访检查确诊为脑缺血的患者，利用Alberta Stroke Program Early CT Score (ASPECTS)评 分标准分析其非增强 CT(Noncontrast CT, NCCT)的影像学表现特征，和CT灌注扫描以 及CT和MRI随访结果对比，研究CT平扫在早期脑缺血诊断中的作用。结果：21例经过CTP和（ 或）MRI随访检查确诊为早期脑缺血患者中，缺血核区CBF和CBV均较正常脑组织明显下降（ P0.05)。经NCCT扫描发现脑缺血病变的患者11例，其中8例主要表现为患侧密度降低， 3例主要表现为患侧脑组织水肿、脑沟变浅，ASPECTS评分分析的26个异常区域中，有19个区 域表现为密度降低，7个表现为脑组织肿胀。结论：早期脑缺血患者中，NCCT所见的低密度 区大致和缺血核区域相符，脑组织肿胀区域大致和半暗带区相符。虽然平扫CT不能准确判断 半暗带和缺血核区，但是对早期脑缺血性疾病能提供很多有用的信息。 关键词：非增强CT;CT灌注扫描;脑缺血;半暗带 中图分类号： R814.42；R743 文献标识码： A 文章编号： 1008-2409(2008)05-0905-02 Identification of the penumbra and infarct core on noncontrast CT scan/ZHOU Zhi-peng, QIU Wei-jia, ZHANG Hui-yang,et al.∥Department of Radiology, The Affiliated Hospital of Guilin Medical College, Guil in 541001, China Abstract: Objective:To value the noncontrast CT (NCCT) imaging in the assessment of cere bral perfusion and infarction. Methods: Examinations of plain scan were carried out in 21 cases with acute ischemic cerebrovascular disease. Five ratersindepende ntly scored noncontrast CTs blind to clinical data using the Alberta Stroke Prog ram Early CT Score (ASPECTS). Reperfusion and presence of infarction were determ ined from follow-up CTP and MRI. Results: In 21 patients with sub- 24 hou r ischemic stroke, acute CBV was low in parenchymal hypoattenuation(PH) regions,and acute CBF was reduced in isolated focal swelling(ISF) regions, but more soin PH regions. Progression to infarction occurred in virtually all PH regions, b ut IFS regions had much lower rates of infarction with major reperfusion. Conclusions:Perfusion CT can stratify the level of risk of subsequent infarctio n fornormal-appearing regions on noncontrast CT. Isolated focal swelling identifiesp enumbral tissue and parenchymal hypoattenuation identifies infarct core on NCCTimaging.? Key words:noncontrast CT; CT perfusion; stroke; penumbra 急性缺血性脑血管病占脑卒中患者的50%～80%，致残和致死率高，成功的治疗取决于