Department of Medicine, Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
J Neurol Neurosurg Psychiatry. 2013 Jun;84(6):613-8. doi: 10.1136/jnnp-2012-303752. Epub 2013 Jan 25.
CT perfusion (CTP) is rapid and accessible for emergency ischaemic stroke diagnosis. The feasibility of introducing CTP and diagnostic accuracy versus non-contrast CT (NCCT) in a tertiary hospital were assessed.
All patients presenting <9 h from stroke onset or with wake-up stroke were eligible for CTP (Siemens 16-slice scanner, 2×24 mm slabs) unless they had estimated glomerular filtration rate (eGFR)<50 ml/min or diabetes with unknown eGFR. NCCT was assessed by a radiologist and stroke neurologist for early ischaemic change and hyperdense arteries. CTP was assessed for prolonged time to peak and reduced cerebral blood flow. Technical adequacy was defined as 2 CTP slabs of sufficient quality to diagnose stroke.
Between January 2009 and September 2011, 1152 ischaemic stroke patients were admitted, 475 (41%) were <9 h/wake-up onset. Of these, 276 (58%) had CTP. Reasons for not performing CTP were diabetes with unknown eGFR (48 (10%)), known kidney disease (36 (8%)), established infarct on NCCT (27 (6%)), posterior circulation syndrome (25 (5%)) and patient motion/instability (16 (3%)). Clinician discretion excluded a further 47 (10%). CTP was more frequently diagnostic than NCCT (80% vs 50%, p<0.001). Non-diagnostic CTP was due to lacunar infarction (28 (10%)), infarct outside slab coverage (21 (8%)), technical failure (4 (1%)) and reperfusion (2 (0.7%)). Normal CTP in 86/87 patients with stroke mimics supported withholding tissue plasminogen activator. CTP technical adequacy improved from 56% to 86% (p<0.001) after the first 6 months. Median time for NCCT/CTP/arch-vertex CT angiogram (including processing and interpretation) was 12 min. No clinically significant contrast nephropathy occurred.
CTP in suspected stroke is widely applicable, rapid and increases diagnostic confidence.
CT 灌注（CTP）在紧急缺血性脑卒中的诊断中快速且易于实现。本研究旨在评估在一所三级医院中引入 CTP 的可行性及其相对于非对比 CT（NCCT）的诊断准确性。
所有发病时间<9 小时或为觉醒性脑卒中的患者均有资格进行 CTP（西门子 16 层扫描仪，2×24mm 层厚）检查，除非患者估算肾小球滤过率（eGFR）<50ml/min 或患有未知 eGFR 的糖尿病。NCCT 由放射科医生和脑卒中神经科医生评估是否有早期缺血性改变和高密度动脉征。CTP 用于评估峰值时间延长和脑血流减少。技术适宜性定义为 2 张质量足够好以诊断脑卒中的 CTP 层面。
2009 年 1 月至 2011 年 9 月，共收治了 1152 例缺血性脑卒中患者，其中<9 小时/觉醒发病的患者为 475 例（41%）。这其中，276 例（58%）进行了 CTP 检查。未行 CTP 的原因包括：患有未知 eGFR 的糖尿病（48 例[10%]）、已知的肾脏疾病（36 例[8%]）、NCCT 上有已确定的梗死灶（27 例[6%]）、后循环综合征（25 例[5%]）和患者运动障碍/不稳定（16 例[3%]）。临床医生决定不进行 CTP 的又排除了 47 例（10%）。CTP 的诊断率高于 NCCT（80% vs 50%，p<0.001）。非诊断性 CTP 归因于腔隙性梗死（28 例[10%]）、梗死灶超出层面覆盖范围（21 例[8%]）、技术失败（4 例[1%]）和再灌注（2 例[0.7%]）。87 例脑卒中模拟患者的 86 例 CTP 正常，支持不使用组织型纤溶酶原激活剂。CTP 的技术适宜性在头 6 个月后从 56%提高到了 86%（p<0.001）。NCCT/CTP/颅顶 CT 血管造影（包括处理和解释）的中位时间为 12 分钟。未发生有临床意义的对比剂肾病。
疑似脑卒中患者中 CTP 广泛适用，快速且能提高诊断信心。
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