急性缺血性脑卒中的三联征检查：脑、颈动脉、主动脉和心脏成像。
The triple rule-out for acute ischemic stroke: imaging the brain, carotid arteries, aorta, and heart.
机构信息
Department of Radiology, University of California, San Francisco, San Francisco, California, USA.
出版信息
AJNR Am J Neuroradiol. 2010 Aug;31(7):1290-6. doi: 10.3174/ajnr.A2075. Epub 2010 Apr 1.
BACKGROUND AND PURPOSE
Ischemic stroke is commonly embolic, either from carotid atherosclerosis or from cardiac origin. These potential sources of emboli need to be investigated to accurately prescribe secondary stroke prevention. Moreover, the mortality in ischemic stroke patients due to ischemic heart disease is greater than that of age-matched controls, thus making evaluation for coronary artery disease important in this patient population. The purpose of this study was to evaluate the image quality of a comprehensive CTA protocol in patients with acute stroke that expands the standard CTA coverage to include all 4 chambers of the heart and the coronary arteries.
MATERIALS AND METHODS
One hundred twenty patients consecutively admitted to the emergency department with suspected cerebrovascular ischemia undergoing standard-of-care CTA were prospectively enrolled in our study. We used an original tailored acquisition protocol using a 64-section CT scanner, consisting of a dual-phase intravenous injection of iodinated contrast and saline flush, in conjunction with a dual-phase CT acquisition, ascending from the top of the aortic arch to the vertex of the head, then descending from the top of the aortic arch to the diaphragm. No beta blockers were administered. The image quality, attenuation, and CNRs of the carotid, aortic, vertebral, and coronary arteries were assessed.
RESULTS
Carotid, aorta, and vertebral artery image quality was 100% diagnostic (rated good or excellent) in all patients. Coronary artery image quality was diagnostic in 58% of RCA segments, 73% of LAD segments, and 63% of LCX segments. When we considered proximal segments only, the diagnostic quality rose to 71% in the RCA, 83% in the LAD, and 74% in the LCX.
CONCLUSIONS
Our stroke protocol achieved excellent opacification of the left heart chambers, the cervical arteries, and each coronary artery, in addition to adequate carotid and coronary artery image quality.
背景与目的
缺血性脑卒中通常为栓塞性，来源于颈动脉粥样硬化或心源性。这些潜在的栓子源需要进行调查，以准确地进行二级卒中预防。此外，缺血性心脏病导致的缺血性脑卒中患者的死亡率高于同龄对照组，因此，评估冠状动脉疾病对于这一患者群体非常重要。本研究旨在评估一种扩展至包括左心四腔和冠状动脉的全面 CTA 方案在急性脑卒中患者中的图像质量。
材料与方法
120 例连续就诊于急诊并疑似患有脑血管缺血的患者，在进行标准 CTA 检查的同时，前瞻性地纳入我们的研究。我们使用了一种原始的定制采集方案，使用 64 排 CT 扫描仪，包括双期静脉注射碘造影剂和盐水冲洗，以及双期 CT 采集，从主动脉弓顶部开始，向上延伸至头顶，然后从主动脉弓顶部向下延伸至膈肌。未给予β受体阻滞剂。评估颈动脉、主动脉、椎动脉和冠状动脉的图像质量、衰减和 CNR。
结果
所有患者的颈动脉、主动脉和椎动脉图像质量均为 100%（评为良好或优秀）。冠状动脉图像质量在 RCA 节段为 58%，LAD 节段为 73%，LCX 节段为 63%。当仅考虑近端节段时，RCA 的诊断质量上升至 71%，LAD 的诊断质量上升至 83%，LCX 的诊断质量上升至 74%。
结论
我们的卒中方案实现了对左心腔、颈总动脉和每一条冠状动脉的出色显影，同时也实现了颈动脉和冠状动脉的充分图像质量。
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