目的 CT灌注成像目前已在临床上广泛应用,可定量评估脑血流状态,但其较高的辐射剂量一直受到关注。文中联合扫描方案改良,探讨70 k V管电压在全脑CT灌注成像(CT perfusion,CTP)中的可行性。方法将2014年10月至2015年3月期间于南京军区...目的 CT灌注成像目前已在临床上广泛应用,可定量评估脑血流状态,但其较高的辐射剂量一直受到关注。文中联合扫描方案改良,探讨70 k V管电压在全脑CT灌注成像(CT perfusion,CTP)中的可行性。方法将2014年10月至2015年3月期间于南京军区南京总医院疑诊为缺血性脑血管疾病或因眩晕症状就诊,并行CTP的患者60例以随机数字表法分成2组,每组30例。其中单数日采用80 k V、100 m As的扫描参数行CTP检查,扫描次数为21期者为80 k V组;双数日采用70 k V、120 m As的扫描参数行CTP检查,扫描次数为17期者为70 k V组。评估并比较2组间的灌注参数、主观图像质量评分及辐射剂量。结果 70 k V组尾状核头部、额叶白质及颞枕叶白质的血流量分别为(67.12±6.44)、(30.11±4.39)和(29.69±3.24)m L/(100 m L·min),血容量分别为(4.04±0.37)、(1.90±0.24)和(1.90±0.19)m L/100 g,平均通过时间分别为(3.74±0.64)、(4.79±0.98)和(5.35±1.09)s;与80 k V组同部位血流量(66.46±7.48)、(28.48±3.77)、(29.34±2.84)m L/(100 m L·min),血容量(3.99±0.47)、(1.82±0.23)、(1.82±0.26)m L/100 g,平均通过时间(3.54±0.47)、(4.54±0.89)、(4.95±1.18)s相比,差异无统计学意义(P>0.05);70 k V组血流量与血容量的灰白质对比度评分[(1.93±0.25)、(1.93±0.25)]高于80 k V组[(1.73±0.45)、(1.70±0.54)],差异有统计学意义(P<0.05),但2组总体主观图像质量的差异无统计学差异(P>0.05)。70k V组的辐射剂量较80 k V组降低37%(P<0.05)。结论结合扫描方案改良,70 k V管电压在全脑灌注成像具有可行性。与80 k V的CTP扫描方案相比,在保证图像质量的同时有效降低了辐射剂量,值得推广。展开更多
Cerebral blood perfusion and cerebrovascular lesions are important factors that can affect the therapeutic efficacy of thrombolysis.At present,the majority of studies focus on assessing the accuracy of lesion location...Cerebral blood perfusion and cerebrovascular lesions are important factors that can affect the therapeutic efficacy of thrombolysis.At present,the majority of studies focus on assessing the accuracy of lesion location using imaging methods before treatment,with less attention to predictions of outcomes after thrombolysis.Thus,in the present study,we assessed the efficacy of combined computed tomography（CT） perfusion and CT angiography in predicting clinical outcomes after thrombolysis in ischemic stroke patients.The study included 52 patients who received both CT perfusion and CT angiography.Patients were grouped based on the following criteria to compare clinical outcomes：（1） thrombolytic and non-thrombolytic patients,（2） thrombolytic patients with CT angiography showing the presence or absence of a vascular stenosis,（3） thrombolytic patients with CT perfusion showing the presence or absence of hemodynamic mismatch,and（4） different CT angiography and CT perfusion results.Short-term outcome was assessed by the 24-hour National Institution of Health Stroke Scale score change.Long-term outcome was assessed by the 3-month modified Rankin Scale score.Of 52 ischemic stroke patients,29 were treated with thrombolysis and exhibited improved short-term outcomes compared with those without thrombolysis treatment（23 patients）.Patients with both vascular stenosis and blood flow mismatch（13 patients） exhibited the best short-term outcome,while there was no correlation of long-term outcome with CT angiography or CT perfusion findings.These data suggest that combined CT perfusion and CT angiography are useful for predicting short-term outcome,but not long-term outcome,after thrombolysis.展开更多
文摘目的 CT灌注成像目前已在临床上广泛应用,可定量评估脑血流状态,但其较高的辐射剂量一直受到关注。文中联合扫描方案改良,探讨70 k V管电压在全脑CT灌注成像(CT perfusion,CTP)中的可行性。方法将2014年10月至2015年3月期间于南京军区南京总医院疑诊为缺血性脑血管疾病或因眩晕症状就诊,并行CTP的患者60例以随机数字表法分成2组,每组30例。其中单数日采用80 k V、100 m As的扫描参数行CTP检查,扫描次数为21期者为80 k V组;双数日采用70 k V、120 m As的扫描参数行CTP检查,扫描次数为17期者为70 k V组。评估并比较2组间的灌注参数、主观图像质量评分及辐射剂量。结果 70 k V组尾状核头部、额叶白质及颞枕叶白质的血流量分别为(67.12±6.44)、(30.11±4.39)和(29.69±3.24)m L/(100 m L·min),血容量分别为(4.04±0.37)、(1.90±0.24)和(1.90±0.19)m L/100 g,平均通过时间分别为(3.74±0.64)、(4.79±0.98)和(5.35±1.09)s;与80 k V组同部位血流量(66.46±7.48)、(28.48±3.77)、(29.34±2.84)m L/(100 m L·min),血容量(3.99±0.47)、(1.82±0.23)、(1.82±0.26)m L/100 g,平均通过时间(3.54±0.47)、(4.54±0.89)、(4.95±1.18)s相比,差异无统计学意义(P>0.05);70 k V组血流量与血容量的灰白质对比度评分[(1.93±0.25)、(1.93±0.25)]高于80 k V组[(1.73±0.45)、(1.70±0.54)],差异有统计学意义(P<0.05),但2组总体主观图像质量的差异无统计学差异(P>0.05)。70k V组的辐射剂量较80 k V组降低37%(P<0.05)。结论结合扫描方案改良,70 k V管电压在全脑灌注成像具有可行性。与80 k V的CTP扫描方案相比,在保证图像质量的同时有效降低了辐射剂量,值得推广。
基金supported by the Science and Technical Committee of Shanghai Municipality of China,No.16QA1400900the Outstanding Youth Grant from Shanghai Municipal Commission of Health and Family Planning of China,No.XYQ2013107+1 种基金the China Postdoctoral Science Foundation,No.2016M592595the National Key Research and Development Program of China,No.2016YFA0203700
文摘Cerebral blood perfusion and cerebrovascular lesions are important factors that can affect the therapeutic efficacy of thrombolysis.At present,the majority of studies focus on assessing the accuracy of lesion location using imaging methods before treatment,with less attention to predictions of outcomes after thrombolysis.Thus,in the present study,we assessed the efficacy of combined computed tomography（CT） perfusion and CT angiography in predicting clinical outcomes after thrombolysis in ischemic stroke patients.The study included 52 patients who received both CT perfusion and CT angiography.Patients were grouped based on the following criteria to compare clinical outcomes：（1） thrombolytic and non-thrombolytic patients,（2） thrombolytic patients with CT angiography showing the presence or absence of a vascular stenosis,（3） thrombolytic patients with CT perfusion showing the presence or absence of hemodynamic mismatch,and（4） different CT angiography and CT perfusion results.Short-term outcome was assessed by the 24-hour National Institution of Health Stroke Scale score change.Long-term outcome was assessed by the 3-month modified Rankin Scale score.Of 52 ischemic stroke patients,29 were treated with thrombolysis and exhibited improved short-term outcomes compared with those without thrombolysis treatment（23 patients）.Patients with both vascular stenosis and blood flow mismatch（13 patients） exhibited the best short-term outcome,while there was no correlation of long-term outcome with CT angiography or CT perfusion findings.These data suggest that combined CT perfusion and CT angiography are useful for predicting short-term outcome,but not long-term outcome,after thrombolysis.
