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目的:应用多层螺旋CT (MSCT)借助特殊软件进行脑灌注成像,观察超早期急性脑梗死动态变化。方法:静脉注射1 0 0ml碘海醇,应用西门子SENSATION4型多层螺旋CT ,对2 3例发病6h以内急性缺血性脑血管病扫描观察时间—密度曲线,测定梗死区和对侧正常对照区的血流灌注值局部脑血流量(rCBF) ,局部脑血流容积(rCBV) ,平均通过时间(MTT)等,并获得相应参数的脑灌注CT成像,所有病例至少在发病1周后复查1次普通CT。结果:2 3例急性缺血性脑梗死患者中2 0例其脑梗死侧rCBE比对侧显著降低(P <0 . 0 1 ) ,有1 7例患者1周后复查CT发现其最终梗死面积比6h内脑灌注的面积有缩小(P <0 . 0 5 ) ,证明此组患者在梗死灶中心周围有缺血性半暗区存在,有3例患者1周后CT图象显示最终梗死面积与6h内脑灌注成像面积差异无显著性。结论:多层螺旋CT脑灌注成像可以在急性脑梗死发病6h内超早期明确梗死灶部位及范围,及发现缺血坏死灶周围是否存在缺血性半暗带
Objective: To evaluate the dynamic changes of ultra-early acute cerebral infarction by perfusion imaging with special software by MSCT. Methods: Intravenous injection of 100 ml iohexol was applied to detect the time-density curve of 23 cases of acute ischemic cerebrovascular disease within 6 hours with Siemens SENSATION4 multi-slice spiral CT. The infarction area and contralateral normal control area (RCBF), regional cerebral blood flow volume (rCBV), mean transit time (MTT), etc. The corresponding parameters of cerebral perfusion CT imaging were obtained. All cases were reviewed at least 1 week after onset Common CT. Results: Twenty-two of 23 acute ischemic stroke patients had significantly lower rCBE on the infarct side than those on the contralateral side (P <0.01), and the final infarct size was found in 1 of 7 patients after one-week follow-up CT The area of cerebral perfusion was smaller than that of 6h (P <0.05), which demonstrated that ischemic penumbra existed in the center of infarction in this group of patients. CT images showed the final infarct area in 1 patient after 3 weeks There was no significant difference in the area of cerebral perfusion imaging within 6 hours. Conclusion: MSCT perfusion imaging can clearly identify the infarct location and extent in a very early stage within 6 hours after onset of acute cerebral infarction, and find out whether there is ischemic penumbra around ischemic necrosis