Na Dong Gyu, Ryoo Jae Wook, Lee Kwang Ho, Moon Chan Hong, Yi Chin A, Kim Eung Yeop, Lee Soo Joo, Yi Byong Yong, Kim Jae Hyoung, Byun Hong Sik
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Comput Assist Tomogr. 2003 Mar-Apr;27(2):194-206. doi: 10.1097/00004728-200303000-00016.
The purpose of this study was to compare multiphasic perfusion computed tomography (CT) with diffusion and perfusion magnetic resonance imaging (MRI) in predicting final infarct volume, infarct growth, and clinical severity in patients with hyperacute ischemia untreated by thrombolytic therapy.
Multiphasic perfusion CT was performed in 19 patients with ischemic stroke within 6 hours of symptom onset. Two CT maps of peak and total perfusion were generated from CT data. Diffusion-weighted imaging (DWI) and perfusion MRI were obtained within 150 minutes after CT. Lesion volumes on CT and MRI were compared with final infarct volume and clinical scores, and mismatch on CT or MRI was compared with infarct growth.
The lesion volume on the CT total perfusion map strongly correlated with MRI relative cerebral blood volume (rCBV), and that on the CT peak perfusion map strongly correlated with MRI relative cerebral blood flow (rCBF) and rCBV (P < 0.001). The lesion volume on unenhanced CT or DWI moderately correlated with final infarct volume, but only lesion volume on unenhanced CT weakly correlated with baseline clinical scores (P = 0.024). The lesion volumes on the CT peak perfusion map and MRI rCBF similarly correlated with final infarct volume and clinical scores and more strongly than those on mean transit time (MTT) or time to peak (TTP). DWI-rCBF or CT mismatch was more predictive of infarct growth than DWI-MTT or DWI-TTP mismatch.
Multiphasic perfusion CT is useful and of comparable utility to diffusion and perfusion MRI for predicting final infarct volume, infarct growth, and clinical severity in acute ischemic stroke.
本研究旨在比较多期灌注计算机断层扫描（CT）与扩散加权及灌注磁共振成像（MRI）在预测未经溶栓治疗的超急性缺血患者最终梗死体积、梗死灶扩大及临床严重程度方面的作用。
对19例症状发作6小时内的缺血性卒中患者进行多期灌注CT检查。从CT数据生成峰值灌注和总灌注的两张CT图像。在CT检查后150分钟内进行扩散加权成像（DWI）和灌注MRI检查。将CT和MRI上的病灶体积与最终梗死体积及临床评分进行比较，并将CT或MRI上的不匹配情况与梗死灶扩大进行比较。
CT总灌注图像上的病灶体积与MRI相对脑血容量（rCBV）密切相关，CT峰值灌注图像上的病灶体积与MRI相对脑血流量（rCBF）及rCBV密切相关（P<0.001）。平扫CT或DWI上的病灶体积与最终梗死体积中度相关，但仅平扫CT上的病灶体积与基线临床评分弱相关（P=0.024）。CT峰值灌注图像和MRI的rCBF上的病灶体积与最终梗死体积及临床评分的相关性相似，且比平均通过时间（MTT）或达峰时间（TTP）上的病灶体积相关性更强。DWI-rCBF或CT不匹配比DWI-MTT或DWI-TTP不匹配更能预测梗死灶扩大。
多期灌注CT在预测急性缺血性卒中的最终梗死体积、梗死灶扩大及临床严重程度方面是有用且与扩散加权及灌注MRI具有相当效用的。
