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A study on the application of CT perfusion and CT angiography with 64-slice spiral CT in the evaluation of internal carotid artery and middle cerebral artery stenosis and occlusion

GAO Yan LI Kun-cheng DU Xiang-ying LU Jie LIU Jia-bin YANG Yan-hui SHEN Yun Department of Radiology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China  
Objective To evaluate clinical application of combined cerebral CT perfusion(CTP) with head and neck CT angiography(CTA)using 64-slice spiral CT on the cerebral ischemia caused by the stenosis or occlusion of internal carotid artery(ICA)and middle cerebral artery(MCA).Methods The sixty nine patients with unilateral or bilateral ICA and MCA stenosis or occlusion confirmed by digital subtraction angiography underwent head plain CT scan,cerebral CTP,and head and neck CTA using 64-slice spiral CT.Ten normal adults served as control.To discriminate the ischemie foci,the parameter maps of cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT)and time to peak(TTP)were obtained.Results Among the patients with unilateral ICA stenosis or occlusion diagnosed by CTA,abnormal perfusion was found only in the watershed zone in 5 cases,both the MCA territory and the watershed zone were involved in 10 cases.Of 12 patients with severe unilateral ICA stenosis and occlusion, CBF values of the watershed zone in nonsymptmatic and symptomatic sides were(41±9)and(38±8)ml· 100 g~(-1),min~(-1)respectively(t=2.08,P0.05),the MTT values were(5.2±1.1)and(10.9±2.6)s, respectively(t=7.24,P0.01).Thirteen patients with severe bilateral ICA stenosis or occlusion diagnosed by CTA had perfusion abnormalities in the both the MCA territory and the watershed zone.Of 25 patients with unilateral MCA stenosis,4 patients were normal in CT perfusion,17 patients had perfusion abnormalities in MCA territory,and 4 patients had perfusion abnormalities in both MCA territory and the watershed zone.Twelve patients with severe bilateral MCA stenosis diagnosed by CTA had perfusion abnormalities in both the MCA territory arid the watershed zone.Compared to normal control,the MTT and TTP were increased,the CBF was decreased,and the CBV in MCA territory and the watershed zone at the symptomatic side was increased.Conclusion The combined examination of CTP with CTA can provide adequate and accurate information for the diagnosis and treatment of middle cerebral artery and internal carotid artery stenosis or occlusion.
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