摘要
目的研究脑灌注成像与踝臂指数(ankle-brachial index,ABI)在急性缺血性脑血管病中的临床应用价值。方法选择本院疑似急性缺血性脑血管病患者105例,其中ABI异常组33例,ABI正常组72例。所有患者均行320排动态容积CT全脑灌注扫描,一站式完成颅脑CT血管造影(CT angiography,CTA)和CT灌注成像,获得脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)及延迟(delay)等灌注参数图,由2位高年资的医师共同评价脑灌注图像,计算ABI预测颅脑CT灌注异常的阳性预测值、阴性预测值、灵敏度和特异度。结果所有患者中有68例出现脑灌注异常,表现为MTT、TTP延长,CBV升高、正常或减低,CBF正常或减低。其中ABI异常组有25例脑灌注异常,ABI正常组有43例脑灌注异常,ABI异常组脑灌注阳性率(75.8%,25/33)高于ABI正常组(59.7%,43/72),差异有统计学意义(P=0.039),且ABI异常组的相对MTT、相对TTP大于ABI正常组,差异有统计学意义(P<0.05)。ABI预测颅脑CT灌注异常的阳性预测值、阴性预测值、灵敏度和特异度分别为75.8%、40.3%、36.8%、78.4%。结论应用320排动态容积CT全脑灌注扫描可以早期、全面、准确评价脑血管及血流动力学改变,简便的ABI检查对脑灌注异常有一定的预测价值,二者联合应用,利于早期预防及治疗脑血管病。
Objective To investigate the clinical value of whole-brain CT perfusion combined with ankle-brachial index （ABI） in patients with acute cerebral ischemia. Methods A total of 105 patients who were suspected of having cerebral ischemia were selected in this study, including 33 patients in the abnormal ABI group and 72 patients in normal ABI group. Examination by a 320-detector row whole-brain computed tomography （CT） scan with CT angiography （CTA） and CT perfusion was given to all the patients with stable symptoms. The perfusion parameters, including cerebral blood flow （CBF）, cerebral blood volume （CBV）, mean transit time （MTT）, time to peak （TTP） and delay time, were obtained. The brain perfusion images were evaluated by two experienced physicians, and then the positive predictive value, negative predictive value, sensitivity and specificity of ABI in predicting brain CT perfusion abnormalities were calculated. Results Sixty-eight patients showed brain CT perfusion abnormalities, manifested as prolonged MTT and TTP, increased, normal or reduced CBV, and normal or reduced CBF. The 68 patients included 25 with abnormal ABI and 43 with normal ABI. The rate of positive CT perfusion in the abnormal ABI group （75.8 %, 25/33） was significantly higher than that in the normal ABI group （59.7 %,43/72; P=O. 039）; the relative MTT and the relative TTP in the abnormal ABI group were also significantly longer than those in the normal ABI group （P〈0.05）. The positive predictive value, negative predictive value, sensitivity, and specificity of ABI predicted brain CT perfusion abnormalities were 75. 8%, 40. 3%, 36. 8%, and 78. 4%, respectively. Conclusion Whole-brain CT perfusion can accurately evaluate the hemodynamic changes at an early stage; simple ABI examination has certain predictive value for brain perfusion abnormalities; and the combination of them may facilitate the earlier detection and treatment of cerebral ischemia.
出处
《第二军医大学学报》
CAS
CSCD
北大核心
2013年第12期1340-1344,共5页
Academic Journal of Second Military Medical University
关键词
脑缺血
X线计算机体层摄影术
脑灌注
踝臂指数
brain ischemia
X ray computed tomography
brain perfusion
ankle-brachial index
