摘要目的：探讨早期脑梗死诊断中多层 CT 脑灌注成像的初步应用。方法选取2013年5月至2014年5月收治的疑有脑梗死的患者10例,发病时间1~24 h,采用 CT 脑灌注检查及常规 CT 平扫,同时行 MRI 检查4例,回顾性分析其临床资料。结果平扫10例均无梗死灶,4例在 CT 脑灌注后,左侧额颞顶部有异常的大面积灌注区4例。相较对侧,异常区域血管明显减少,脑血容量图(CBV)、脑血流量图(CBF)下降,对比剂峰值时间图(TTP)未出现,对比剂平均通过时间图(MTT)延长,4例发病时间分别为1、2、3、4 h。观察发病1 h MRI T1、T2加权及 DWI,无异常信号存在；T1、T2加权像信号改变不明显,DWI 呈异常高信号表现,但相较 CT 灌注显示图像,病灶范围较小。分别做 MTT、CBF、CBV 相较对侧,检查结果差异有统计学意义(P <0.05)。4例均未溶栓治疗,CT 平扫(6~14 h 后)复查,梗死灶范围大小与 CBV、CBF 图一致。其他6例 CT 脑灌注后,MTT、CBV、CBF 无明显异常。 CT在7 d 后复查,左侧基底节区小梗死灶2例,脑干梗死灶2例,无异常2例,左放射冠区腔隙性脑梗死2例。结论脑梗死症状出现后40 min 采用 CT 脑灌注成像检测病灶即可显示,有较好的超早期诊断特异性,可为早期诊治提供准确的参考依据,促使预后最大程度的改善,但脑梗死灶在部位小处发生时,意义相对稍弱。

abstractsObjective To investigate the preliminary application of multi-slice CT cerebral perfusion imaging in the diagnosis of early cerebral infarction. Methods Ten patients with suspected cerebral infarction, onset time 1 - 24 h, from May 2013 to May 2014 were selected. They underwent conventional CT brain perfusion examination and CT scan, and 4 cases had MRI examination, the clinical data were retrospectively analyzed. Results Unenhanced 10 cases had no infarc-tion, after the CT brain perfusion, in the left frontal and parietal temporal, there were four cases of large perfusion abnormali-ties. Compared to the opposite side, the abnormal blood vessels significantly reduced, CBV, CBF decreased, TTP did not ap-pear, MTT extended, four cases of onset time was 1, 2, 3, 4 h. Observe the onset 1 h MRIT1, T2-weighted and DWI, no abnormal signal was present; T1, T2-weighted image signal change was not obvious, DWI showed abnormal high signal per-formance, but the display was small compared with CT perfusion images, the lesions range. Respectively, for MTT, CBF, CBV compared with the contralateral, test&nbsp;results were significantly different (P <0. 05). Four cases didn’t have thrombolytic therapy, CT scan (6 - 14 h after) re-view, infarct size and CBV, CBF map unanimous. The other six cases of CT brain perfusion, MTT, CBV, CBF had no obvi-ous abnormality. Seven days after the review of CT in the left basal ganglia infarction, two cases of small brainstem infarc-tion, two cases without exception, 2 cases of left corona radiata lacunar infarction. Conclusions After infarction symptoms occurred for 40 min, using CT brain perfusion imaging can detect lesions, show better early diagnosis of specificity, can provide accurate reference for the early diagnosis and treatment, promote the greatest degree of improvement in the progno-sis, but infarction occur in parts of the small office, meaning relatively weaker.