多层螺旋CT血管成像在诊断急性缺血性脑卒中的临床应用价值
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摘要
目的:探究头颈部多层螺旋CT血管成像技术对急性缺血性脑卒中(AIS)的诊断价值。方法:选取医院收治的173例AIS患者,均接受溶栓、血管内取栓、支架等治疗,并于治疗前后分别使用多层螺旋CT血管成像(CTA)及灌注成像(CTPI)进行检查,对CTA获得图像进行处理,分析不同成像方法对AIS患者的诊断价值。结果:CTPI扫描中脑血流量(CBF)和平均通过时间(MTT)的诊断准确率及灵敏度明显高于CT平扫,其差异有统计学意义(x~2=8.694,x~2=9.430,x~2=24.967,x~2=42.564;P<0.05);CTA扫描中颅内动脉的诊断准确率及灵敏度均高于CT平扫,差异有统计学意义(x~2=10.221,x2=45.983;P<0.05);颈内动脉CTA诊断准确率低于CT平扫,差异有统计学意义(x2=5.026,P<0.05);CTPI扫描和CTA两种诊断方法的特异度与CT平扫比较,差异无统计学意义(x~2=0.023,x~2=0.878;P>0.05)。结论:经头部多层螺旋CTA检查和CTPI检查,均可较好的对AIS进行诊断,为临床疾病的治疗和预防提供科学、有效依据支持,值得临床应用。
Objective: To investigate the value of multi-slice spiral CT angiography(CTA) in the diagnosis and treatment of acute ischemic stroke(AIS). Methods: A total of 173 patients with AIS admitted to our hospital were enrolled in this study. All of patients were treated with thrombolytic therapy, intravascular taking away thrombus, stent treatment and others treatment. Multi-slice spiral CTA and CT perfusion imaging(CTPI) were used to implement examination before and after treatment. And the images obtained by CTA were further processed. In addition, the values of different imaging methods in the diagnosis and treatment for patients with AIS were analyzed. Results: The diagnostic accuracy and sensitivity of CBF and MTT in CTPI scan were significantly higher than those in CT plain scan(x~2=8.694, x~2=9.430, x~2=24.967, x~2=42.564, P<0.05), respectively. The diagnostic accuracy and sensitivity of intracranial arteries in CTA scan were significantly higher than those in CT plain scan(x~2=10.221, x~2=45.983, P<0.05), respectively. The diagnostic accuracy of internal carotid in CTA scan was significantly lower than that in CT plain scan(x~2=5.026, P<0.05). The differences of specificities of CTPI scan and CTA scan were no significant with CT plain scan(x~2=0.023, x~2=0.878, P>0.05), respectively. Conclusion: According to the results of the study, the multi-slice spiral CTA examination and CTPI examination can better diagnose AIS, and they can provide scientific and effective basis in supporting treatment and prevention for clinical disease. Therefore, they are worthy in clinical application.
Objective: To investigate the value of multi-slice spiral CT angiography(CTA) in the diagnosis and treatment of acute ischemic stroke(AIS). Methods: A total of 173 patients with AIS admitted to our hospital were enrolled in this study. All of patients were treated with thrombolytic therapy, intravascular taking away thrombus, stent treatment and others treatment. Multi-slice spiral CTA and CT perfusion imaging(CTPI) were used to implement examination before and after treatment. And the images obtained by CTA were further processed. In addition, the values of different imaging methods in the diagnosis and treatment for patients with AIS were analyzed. Results: The diagnostic accuracy and sensitivity of CBF and MTT in CTPI scan were significantly higher than those in CT plain scan(x~2=8.694, x~2=9.430, x~2=24.967, x~2=42.564, P<0.05), respectively. The diagnostic accuracy and sensitivity of intracranial arteries in CTA scan were significantly higher than those in CT plain scan(x~2=10.221, x~2=45.983, P<0.05), respectively. The diagnostic accuracy of internal carotid in CTA scan was significantly lower than that in CT plain scan(x~2=5.026, P<0.05). The differences of specificities of CTPI scan and CTA scan were no significant with CT plain scan(x~2=0.023, x~2=0.878, P>0.05), respectively. Conclusion: According to the results of the study, the multi-slice spiral CTA examination and CTPI examination can better diagnose AIS, and they can provide scientific and effective basis in supporting treatment and prevention for clinical disease. Therefore, they are worthy in clinical application.
引文
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[8]张祖建,张勇,陈淑君,等.MSCTA、2D DSA和3DDSA对颈动脉狭窄测量差异比较的实验研究[J].重庆医学,2015,44(3):359-361.
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[10]梁立华,林景兴,陈志军,等.64层CT脑CTP联合头颈CTA对缺血性脑卒中早期诊断的临床应用研究[J].CT理论与应用研究,2016,25(4):453-461.
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[12]张良金,石安斌,王小艳,等.早期缺血性脑卒中的CT灌注及血管成像分析[J].海南医学,2017,28(9):1442-1444.
[13]魏新华,江新青,吴梅,等.320排CT灌注成像时间间隔增加对缺血性脑卒中患者放射剂量的影响[J].影像诊断与介入放射学,2012,21(4):256-259.
[14]中华医学会神经病学分会.中国脑血管病影像应用指南[J].中华神经科杂志,2016,49(3):164-181.
[15]韩玺河,车丽红,邹梅,等.急性缺血性脑血管病76例多模式CT影像学分析[J].脑与神经疾病杂志,2017,25(3):141-145.
[16]洪静静,包权,刘新亮,等.不同成像方法对脑梗死急性期诊断价值的研究进展[J].中国当代医药,2018,25(14):29-31.
[2]Biesbroek JM,Niesten JM,Dankbaar JW,et al.Diagnostic Accuracy of CT Perfusion Imaging for Detecting Acute Ischemic Stroke:a Systematic Review and Meta-Analysis[J].Cerebrovascular Diseases,2013,35(6):493-501.
[3]陈志军,梁立华,林景兴,等.脑CTP联合头颈CTA对脑卒中侧支循环诊断的价值[J].中国CT和MRI杂志,2016,14(3):44-47.
[4]Van ST,Biessels GJ,Kappelle LJ,et al.The Prognostic Value of CT Angiography and CT Perfusion in Acute Ischemic Stroke[J].Cerebrovascular Diseases,2015,40(5-6):258.
[5]王薇薇,王新德.第六届全国脑血管病学术会议纪要[J].中华神经科杂志,2004,37(4):346-348.
[6]张军,张天瑜,潘嘉伟,等.256层CT灌注成像监测急性缺血性脑卒中溶栓前后脑血流动力学变化[J].中国医学计算机成像杂志,2016,22(5):393-397.
[7]刘美云,徐忠宝,段红莲,等.CT血管成像及灌注成像与前循环脑梗死[J].中风与神经疾病杂志,2013,30(1):56-59.
[8]张祖建,张勇,陈淑君,等.MSCTA、2D DSA和3DDSA对颈动脉狭窄测量差异比较的实验研究[J].重庆医学,2015,44(3):359-361.
[9]许晓敬,贾阳娟,韩凝,等.NIHSS评分对急性脑梗死颅内大动脉闭塞的预测价值[J].脑与神经疾病杂志,2016,24(9):544-548.
[10]梁立华,林景兴,陈志军,等.64层CT脑CTP联合头颈CTA对缺血性脑卒中早期诊断的临床应用研究[J].CT理论与应用研究,2016,25(4):453-461.
[11]Tom VS,Jan BG,Van d SIC,et al.Prediction of outcome in patients with suspected acute ischaemic stroke with CT perfusion and CT angiography:the Dutch acute stroke trial(DUST)study protocol[J].Bmc Neurology,2014,14(1):37-37.
[12]张良金,石安斌,王小艳,等.早期缺血性脑卒中的CT灌注及血管成像分析[J].海南医学,2017,28(9):1442-1444.
[13]魏新华,江新青,吴梅,等.320排CT灌注成像时间间隔增加对缺血性脑卒中患者放射剂量的影响[J].影像诊断与介入放射学,2012,21(4):256-259.
[14]中华医学会神经病学分会.中国脑血管病影像应用指南[J].中华神经科杂志,2016,49(3):164-181.
[15]韩玺河,车丽红,邹梅,等.急性缺血性脑血管病76例多模式CT影像学分析[J].脑与神经疾病杂志,2017,25(3):141-145.
[16]洪静静,包权,刘新亮,等.不同成像方法对脑梗死急性期诊断价值的研究进展[J].中国当代医药,2018,25(14):29-31.