急性缺血性脑卒中的三维血流成像（英文）

3D Blood Volume Imaging Acute Ischemic Stroke,Kuncheng Li M.D.,Ph.D.,Medical Imaging Center Department of Radiology Xuanwu Hospital Capital Medical University Beijing 100053 China,Non-enhanced CT (NECT) : could exclude hemorrhage and indicate early signs of ischemic stroke Perfusion CT (PCT) : shows hemodynamic status CT angiography (CTA) : shows vascular occlusion location,Comprehensive Imaging in 15 Minutes,Perfusion CT ,Images from PCT: MIP CBF CBV TTP,BUT: limited coverage,Whole brain perfusion is ideal!,Calculating 3D-PBV Images,CTA,low pass filtering,NECT,Registration,uses information,3D PBV,Skull,Bones,CSF,Bones,Vessels,Pre-Studies of 3D-PBV,Materials and Methods,Twenty-five patients (7 women, 18 men; mean age 59 years; range 42-77 years) suffered from acute ischemic stroke of the anterior circulation were studied within 6h after onset of symptoms NECT, CTA and CTP were performed within an average time of 2.8 hours (range 1-6 hours) after onset of symptoms Intravenous or intra-arterial thrombolytic therapy was performed in 11 of 25 patients Follow-up CT and MRI examinations were done at 2 to 7 days for the depiction of definite infarction,NECT: spiral mode covering the base to vertex reconstruct with 5/1mm slice thickness CTP: dynamic scan 3 adjacent slices (28.8 mm thickness) covering the basal ganglia 40 ml non-ionic contrast, 8 ml/sec CTA: spiral mode covering C5 to vertex 60 ml non-ionic contrast, 4 ml/sec,CT Scan Protocol,Results,NECT: signs of ischemia were demonstrated in 13 of 25 acute stroke patients CTP: CBF, CBV, and TTP demonstrated perfusion deficits in 21 patients CBF, CBV, and TTP demonstrated suspected perfusion deficits in 2 patients Only TTP demonstrated perfusion deficits in 2 of 25 patients 3D-PBV: demonstrated perfusion deficits in all of the 25 acute stroke patients,3D-PBV has a higher detection rate for infarct lesion than NECT and CTP, and can depict the whole infarction lesion,Results,CTP: lesion volume significantly correlated with the follow-up CT (R=0.776/P0.001 for CBF; R=0.723/ P0.001 for CBV; R=0.629/P=0.001 for TTP) PBV: lesion volume significantly correlated with the follow-up CT (R=0.837, P0.001),Volume cm3,R=0.776P0.001,R=0.723P0.001,R=0.629P=0.001,R=0.837P0.001,CBF-follow-up CT,CBV-follow-up CT,TTP-follow-up CT,PBV-follow-up CT,Results,Thrombolysis Group,CTP: the lesion volume significantly correlated with the follow-up plain CT CBF R=0.811,P0.001 CBV R=0.829,P0.001 TTP R=0.807,P0.001 PBV: the lesion volume significantly correlated with the follow-up plain CT R=0.851,P0.001,Thrombolysis Group,R=0.755P=0.007,PBV-follow-up CT,CBF-follow-up CT,CBV-follow-up CT,TTP-follow-up CT,R=0.851P0.001,R=0.811P0.001,R=0.829P0.001,R=0.807P0.001,Conclusions,3D PBV can improve detection rate of ischemia by avoiding lesion omitting and assess the full extent of ischemia which correlates well with follow-up plain CT 3D PBV requires no additional scan or contrast injection and can be performed in a short period of time. The integration of 3D-PBV with multimodal CT (NECT, CTP and CTA) can add the diagnostic value in acute ischemic stroke,TEXT,NECT,CTA,CTP,3D-PBV,Acute Ischemic Stroke New Multimodal CT Protocol,Jie Lu M.D.,Ph.D. Miao