多模态CT对预测自发性蛛网膜下腔出血迟发性脑梗死的价值

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摘要目的：探讨多模态CT预测自发性蛛网膜下腔出血（SAH）患者迟发性脑梗死（DCI）的价值。方法：随机对82例自发性SAH患者进行多模态CT检查，所有患者发病72 h内急诊行多层螺旋头颅CT平扫、CT灌注成像（CTP）及CT血管造影（CTA）检查，并于发病14 d内行CT平扫随访，根据两次CT平扫结果判断是否发生DCI，将患者分为DCI组（n=30）和无DCI组（NDCI组，n=52）。结果：发病72 h内，2组CTP定量比较，DCI组与NDCI组平均相对脑血流量（rCBF）分别为0.82和1.02（P＜0.01），平均相对脑血容量（rCBV）为0.90和1.03（P＜0.01），平均相对通过时间（rMTT）分别为1.24和0.97（P＜0.01），SAH的初期，DCI组的脑血流动力学已经发生改变。CTP预测DCI的敏感性、特异性分别为100.0%、42.3%，假阴性率为0，假阳性率57.7%。而CTA预测DCI的敏感性、特异性分别为20.0%、88.5%，假阴性率为80.0%，假阳性率为11.5%。结论：CTP联合CTA检查，有助于临床医生全面了解SAH的脑血管形态和脑组织灌注情况，定量了解脑组织血流动力学变化情况，对早期预判DCI及其范围、指导临床早期干预治疗具有重要的意义。

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	段玉霞1
	陈伟建1
	郭献忠1
	李刚2
	李瑞1
	林怡1
	张悦1
	胡子龙1

关键词 ：体层摄影术, X线计算机；蛛网膜下腔出血；灌注成像

Abstract：Objective: To investigate the value of Multi-mode CT scan in predicting delayed cerebral infarction (DCI) after spontaneous subarachnoid hemorrhage (SSAH). Methods: Eighty-two patients were scanned with head Multi-mode CT in 72 hours after SSAH attacking, including plain CT scan, computer tomography angiography (CTA) scan and computer tomography perfusion (CTP) scan. All of the 82 patients received plain CT scan again in 14 days. A total of 82 patients were classified into two groups: DCI group (n=30) and NDCI group (n=52). Results: After quantitative comparison of CTP of both groups, the average rCBF was 0.82 and 1.02 (P<0.01), the average rCBV was 0.90 and 1.03 (P<0.01), and the average rMTT was 1.24 and 0.97 (P<0.01). Brain hemodynamics began to change in early days in SAH patients. The sensitivity, specificity, false negative rates and false positive rates of CTP and CTA’s value in predicting DCI were 100.0%, 42.3%, 0, 57.7% and 20.0%, 88.5%, 80.0%, 11.5%, respectively. All of these were calculated at the base of plain CT scan. Conclusion: Brain CTA combined with CTP will be helpful for clinician to comprehend the shape of cerebral vessel and the perfusion of brain tissue in patients with SAH. The brain blood flow changes can be known quantitatively. Also it is meaningful in early predicating DCI and its range, and guiding the early intervention of the DCI.

Key words： tomography, X-ray computer subarachnoid hemorrhage perfusion imaging

收稿日期: 2014-10-22

基金资助:温州市科技计划项目（Y20140027，Y20140733）。

通讯作者: 陈伟建，主任医师，硕士生导师，Email：wyyycwj@ 163.com。

作者简介: 段玉霞（1981-），女，湖北襄阳人，主治医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2015/V45/I12/879

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