脑缺血时 CT 灌注评估：模式与陷阱。
Evaluation of CT perfusion in the setting of cerebral ischemia: patterns and pitfalls.
机构信息
Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10467, USA.
出版信息
AJNR Am J Neuroradiol. 2010 Oct;31(9):1552-63. doi: 10.3174/ajnr.A2026. Epub 2010 Feb 25.
Abstract
CTP has a growing role in evaluating stroke. It can be performed immediately following NCCT and has advantages of accessibility and speed. Differentiation of salvageable ischemic penumbra from unsalvageable core infarct may help identify patients most likely to benefit from thrombectomy or thrombolysis. Still, CTP interpretation can be complex. We review normal and ischemic perfusion patterns followed by an illustrative series of technical/diagnostic challenges of CTP interpretation in the setting of acute stroke syndromes.
摘要
CTP 在评估中风方面的作用日益凸显。它可以在 NCCT 之后立即进行，具有便捷性和快速性的优势。鉴别可挽救的缺血半暗带与不可挽救的核心梗死灶，有助于确定最有可能从取栓或溶栓治疗中获益的患者。尽管如此，CTP 解读可能较为复杂。我们首先回顾了正常和缺血灌注模式，然后展示了一系列急性脑卒中综合征背景下 CTP 解读的技术/诊断挑战实例。
相似文献
1
Evaluation of CT perfusion in the setting of cerebral ischemia: patterns and pitfalls.脑缺血时 CT 灌注评估：模式与陷阱。
AJNR Am J Neuroradiol. 2010 Oct;31(9):1552-63. doi: 10.3174/ajnr.A2026. Epub 2010 Feb 25.
2
Optimal thresholds for ischemic penumbra predicted by computed tomography perfusion in patients with acute ischemic stroke treated with mechanical thrombectomy.采用机械取栓治疗的急性缺血性脑卒中患者，通过计算机断层灌注预测的缺血半暗带的最佳阈值。
J Neurointerv Surg. 2018 Mar;10(3):279-284. doi: 10.1136/neurintsurg-2017-013083. Epub 2017 Jun 9.
3
Perfusion computed tomography thresholds defining ischemic penumbra and infarct core: studies in a rat stroke model.定义缺血半暗带和梗死核心的灌注计算机断层扫描阈值：大鼠中风模型研究
Int J Stroke. 2015 Jun;10(4):553-9. doi: 10.1111/ijs.12147. Epub 2013 Oct 21.
4
Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 2: technical implementations.急性缺血性卒中CT灌注成像的理论基础与技术实现，第2部分：技术实现
AJNR Am J Neuroradiol. 2009 May;30(5):885-92. doi: 10.3174/ajnr.A1492. Epub 2009 Mar 19.
5
Admission CT perfusion may overestimate initial infarct core: the ghost infarct core concept.入院时的CT灌注可能高估初始梗死核心：“幽灵梗死核心”概念。
J Neurointerv Surg. 2017 Jan;9(1):66-69. doi: 10.1136/neurintsurg-2016-012494. Epub 2016 Aug 26.
6
Noncontrast Computed Tomography versus Computed Tomography Angiography Source Images for Predicting Final Infarct Size in Anterior Circulation Acute Ischemic Stroke: a Prospective Cohort Study.非增强计算机断层扫描与计算机断层扫描血管造影源图像预测前循环急性缺血性卒中最终梗死体积的前瞻性队列研究
J Stroke Cerebrovasc Dis. 2017 Feb;26(2):339-346. doi: 10.1016/j.jstrokecerebrovasdis.2016.09.026. Epub 2016 Oct 24.
7
Non-contrast dual-energy CT virtual ischemia maps accurately estimate ischemic core size in large-vessel occlusive stroke.非对比双能 CT 虚拟缺血图能准确估计大血管闭塞性卒中的缺血核心大小。
Sci Rep. 2021 Mar 24;11(1):6745. doi: 10.1038/s41598-021-85143-3.
8
The Prognostic Value of CT Angiography and CT Perfusion in Acute Ischemic Stroke.CT血管造影和CT灌注在急性缺血性卒中中的预后价值
Cerebrovasc Dis. 2015;40(5-6):258-69. doi: 10.1159/000441088. Epub 2015 Oct 21.
9
"Code-Stroke" CT Perfusion; Challenges and Pitfalls.“Code-Stroke” CT 灌注；挑战与陷阱。
Acad Radiol. 2019 Nov;26(11):1565-1579. doi: 10.1016/j.acra.2018.12.013. Epub 2019 Jan 14.
10
Imaging of stroke: Part 1, Perfusion CT--overview of imaging technique, interpretation pearls, and common pitfalls.卒中影像：第 1 部分，灌注 CT——成像技术概述、解读要点和常见误区。
AJR Am J Roentgenol. 2012 Jan;198(1):52-62. doi: 10.2214/AJR.10.7255.
引用本文的文献
1
Imaging characteristics of brain microstructure and cerebral perfusion in Crohn's disease patients with anxiety: A prospective comparative study.克罗恩病伴焦虑患者脑微观结构及脑灌注的影像学特征：一项前瞻性对照研究。
World J Gastroenterol. 2025 Jan 28;31(4):99014. doi: 10.3748/wjg.v31.i4.99014.
2
Device-assisted strategies for drug delivery across the blood-brain barrier to treat glioblastoma.通过血脑屏障进行药物递送以治疗胶质母细胞瘤的设备辅助策略。
Commun Mater. 2025;6(1):5. doi: 10.1038/s43246-024-00721-y. Epub 2025 Jan 7.
3
CT perfusion imaging in aneurysmal subarachnoid hemorrhage. State of the art.动脉瘤性蛛网膜下腔出血的CT灌注成像。现状。
Front Radiol. 2024 Oct 7;4:1445676. doi: 10.3389/fradi.2024.1445676. eCollection 2024.
4
The Role of CT Perfusion in Differentiating Benign Versus Malignant Focal Pulmonary Lesions.CT灌注成像在鉴别肺部局灶性病变良恶性中的作用
Cureus. 2024 Jul 1;16(7):e63618. doi: 10.7759/cureus.63618. eCollection 2024 Jul.
5
What You Always Wanted to Know about Endovascular Therapy in Acute Ischemic Stroke but Never Dared to Ask: A Comprehensive Review.你一直想了解但却不敢问的关于急性缺血性卒中血管内治疗的知识：一项综述
Rev Cardiovasc Med. 2022 Oct 11;23(10):340. doi: 10.31083/j.rcm2310340. eCollection 2022 Oct.
6
Deep learning-based correction for time truncation in cerebral computed tomography perfusion.基于深度学习的脑 CT 灌注时间截断校正。
Radiol Phys Technol. 2024 Sep;17(3):666-678. doi: 10.1007/s12194-024-00818-6. Epub 2024 Jun 11.
7
Quantification of Infarct Core Volume in Patients with Acute Ischemic Stroke Using Cerebral Metabolic Rate of Oxygen in CT Perfusion.利用 CT 灌注脑氧代谢率对急性缺血性脑卒中患者梗死核心体积进行定量分析。
AJNR Am J Neuroradiol. 2024 Oct 3;45(10):1432-1440. doi: 10.3174/ajnr.A8360.
8
Assessment of computed tomography perfusion RAPID estimated core volume accuracy in patients following thrombectomy.血栓切除术患者计算机断层扫描灌注RAPID估计核心体积准确性的评估。
Curr J Neurol. 2022 Jan 5;21(1):17-22. doi: 10.18502/cjn.v21i1.9356.
9
Prediction of response to thrombolysis in acute stroke using neural network analysis of CT perfusion imaging.利用 CT 灌注成像的神经网络分析预测急性脑卒中溶栓反应。
Eur Stroke J. 2023 Sep;8(3):629-637. doi: 10.1177/23969873231183206. Epub 2023 Jun 23.
10
A case series of acute ischemic strokes with contralateral perfusion time delay on brain computed tomography.脑 CT 显示对侧灌注时间延迟的急性缺血性脑卒中病例系列。
Medicine (Baltimore). 2023 May 12;102(19):e33790. doi: 10.1097/MD.0000000000033790.
本文引用的文献
1
Radiographic assessment of vasospasm after aneurysmal subarachnoid hemorrhage: the physiological perspective.动脉瘤性蛛网膜下腔出血后血管痉挛的影像学评估：生理学视角
Neurol Res. 2009 Jul;31(6):593-604. doi: 10.1179/174313209X455754.
2
Feasibility of superficial temporal artery as the input artery for cerebral perfusion CT.颞浅动脉作为脑灌注CT输入动脉的可行性。
AJR Am J Roentgenol. 2009 Jun;192(6):W321-9. doi: 10.2214/AJR.07.3677.
3
Automated versus manual post-processing of perfusion-CT data in patients with acute cerebral ischemia: influence on interobserver variability.急性脑缺血患者灌注CT数据的自动与手动后处理：对观察者间变异性的影响
Neuroradiology. 2009 Jul;51(7):445-51. doi: 10.1007/s00234-009-0516-9. Epub 2009 Mar 10.
4
Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 1: Theoretic basis.急性缺血性脑卒中CT灌注成像的理论基础与技术实现，第1部分：理论基础
AJNR Am J Neuroradiol. 2009 Apr;30(4):662-8. doi: 10.3174/ajnr.A1487. Epub 2009 Mar 6.
5
Cortical regional hyperperfusion in nonconvulsive status epilepticus measured by dynamic brain perfusion CT.通过动态脑灌注CT测量非惊厥性癫痫持续状态下的皮质区域血流灌注增加
AJNR Am J Neuroradiol. 2009 Apr;30(4):693-8. doi: 10.3174/ajnr.A1456. Epub 2009 Feb 12.
6
Evaluation of perfusion CT and TIBI grade in acute stroke for predicting thrombolysis benefit and clinical outcome.评估灌注CT和急性卒中TIBI分级对预测溶栓获益和临床结局的作用。
J Neuroradiol. 2009 Jun;36(3):131-7. doi: 10.1016/j.neurad.2008.10.003. Epub 2008 Dec 4.
7
Medical management of cerebral vasospasm: present and future.脑血管痉挛的医学管理：现状与未来。
Neurol Res. 2009 Jul;31(6):626-31. doi: 10.1179/174313209X382331. Epub 2008 Dec 3.
8
Intra-arterial nicardipine infusion improves CT perfusion-measured cerebral blood flow in patients with subarachnoid hemorrhage-induced vasospasm.动脉内输注尼卡地平可改善蛛网膜下腔出血所致血管痉挛患者经CT灌注测量的脑血流量。
AJNR Am J Neuroradiol. 2009 Jan;30(1):160-4. doi: 10.3174/ajnr.A1275. Epub 2008 Oct 22.
9
CT protocol for acute stroke: tips and tricks for general radiologists.急性卒中的CT检查方案：普通放射科医生的小贴士和技巧
Radiographics. 2008 Oct;28(6):1673-87. doi: 10.1148/rg.286085502.
10
Postictal deficit mimicking stroke: role of perfusion CT.模仿中风的发作后缺损：灌注CT的作用
J Neuroradiol. 2009 Mar;36(1):48-51. doi: 10.1016/j.neurad.2008.08.006. Epub 2008 Oct 5.
Zotero 插件