Abstract
目的 评价64层螺旋CT脑灌注成像(CTP)和头颈部CT血管成像(CTA)检查对颈内动脉(ICA)及大脑中动脉(MCA)狭窄和(或)闭塞所致脑缺血的诊断价值.方法 对69例经DSA证实为单、双侧ICA或MCA狭窄和(或)闭塞患者(病例组)及10名正常成年志愿者(对照组)分别进行64层螺旋CT头颅平扫、CTP和CTA检查,观察CTP成像特点,并对各组脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)和达峰时间(TTP)进行定量分析.结果 CTA诊断为单侧ICA狭窄和(或)闭塞的患者17例中,5例仅累及分水岭区,10例同时累及MCA供血区和分水岭区.单侧ICA重度狭窄和(或)闭塞的灌注异常患者12例,非症状侧与症状侧的分水岭区CBF分别为(41±9)和(38±8)ml·100 g-1·min-1,差异无统计学意义(t=2.08,P＞0.05);MTT分别为(5.2±1.1)和(10.9±2.6)s,差异有统计学意义(t=7.24,P＜0.01).CTA诊断为双侧ICA重度狭窄和(或)闭塞的13例中,双侧CTP均表现为MCA供血区加分水岭区灌注缺损.25例单侧MCA狭窄患者,4例灌注正常;17例脑灌注缺损区为MCA供血区,4例为MCA供血区加分水岭区.12例双侧MCA重度狭窄的患者,灌注损伤区均为MCA供血区加分水岭区.结论 64层螺旋CT头颈部CTA联合应用脑CTP检查,为ICA和MCA狭窄和(或)闭塞的临床治疗提供了更为详尽客观的影像依据。
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