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《Chinese Journal of Radiology》 2005-07
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A study of whole brain perfusion CT and CT angiography in hyperacute and acute cerebral infarction

ZHANG Yong-hai,BAI Jun-hu,ZHANG Ming,YANG Guo-cai,TANG Gui-bo,FANG Jun,SHI Wei,LI Xing-hua,LIU Su-ping,LU Qing,TANG Jun. Department of Radiology, Qinghai Provincial People′s Hospital,Xining 810007,China  
Objective To evaluate the diagnostic value of whole-brain perfusion blood volume-weighted CT imaging (PWCT) and simultaneous CT angiography (CTA) on early stage of cerebral ischemic infarction. Methods Non-contrast CT (NCCT), CT perfusion-weighted imaging (PWCT) and delayed CT (DCT) were conducted on 20 cases of early ischemic infarction of whose onset time ranged from 2 to 24 hours. All cases were reexamined with CT or MRI one week to one month later. CT values and perfusion blood volume (PBV) of central and peripheral low perfusion areas as well as those of collateral side were measured. CTA was reconstructed with PWCT as source images to evaluate occlusion or stenosis of blood vessel, and DCT was used to detect the collateral circulation. Results Of the 20 cases, NCCT, PWCT and CTA were negative in 10 cases in which 6 were confirmed as Transient Ischemic Attack (TIA) on reexamined CT and clinical features, and the other 4 were confirmed as lacunar infarction. For the remaining 10 cases, a comparison was made with ANOVA between low perfusion area (central, peripheral inside and outside) and collateral side. The difference was significant (P0.01). However, no significant difference was revealed in the central, peripheral inside and outside areas. PBV values were significant in low perfusion area and collateral side (P0.05). The area of the final infarction was larger than that of the low perfusion area, and the percentage of enlargement exhibited medium negative correlation to the time of ischemia. CTA indicated that 2 cases suffered from left middle cerebral artery occlusion, meanwhile anterior and middle branches of MCA in the other 3 cases were not identified. The sensitivity of NCCT, PWCT and CTA were 28.5%, 71.4% and 35.7% respectively. DCT indicated that 5 cases had asymmetrical blood vessels. Conclusion The whole-brain perfusion-weighted CT imaging and simultaneous CT angiography (CTA) is proved to be a simple, timesaving and effective method for the diagnosis of early stage of ischemic infarction. This method can identify the existence, size, location and corresponding blood-supplying arteries of low perfusion area. It can also predict the existence of ischemic penumbra, providing semi-quantitative and morphological evidence for the clinical treatment of thrombolysis.
【CateGory Index】: R743.3
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