| Objective: To evaluate cerebral hemodynamics in patients with acute ischemiacerebrovascular disease (AICVD), compare with CT perfusion parameters between the side ofischemic lesion and the opposite using CT perfusion (CTP); to discuss the value of CTP in thediagnosis of AICVD. To investigate the relationship between cerebral feeding artery stenosis orocclusion, plaques and cerebral hemodynamic change by combining with CT angiography(CTA); to evaluate clinical application value of CTP and CTA in the patients with AICVD.Methods: 46 patients who suspiciously suffered AICVD undergone conventional cranialCT exclude intracranial hemorrhage and tumor. Then CTP was performed within 24 hours afterthe onset of symptoms by 64 MSCT. The perfusion maps were got by the post-processing, theregion of perfusion defect were reviewed and perfusion parameters of ischemia side andcontralateral side, include of cerebral blood flow (CBF), cerebral blood volume (CBV), meantransit time (MTT), were recorded. CTA was performed five minutes later after CTPexamination, reconstructed by volume rendering (VR), maximum intensity projection (MIP),multiplanar reformation (MPR), curved planar reformations (CPR) technology to observe arterystenosis and plaque, their distribution, plaque types and calculate stenosis ratios. Statisticalanalysis was executed by SPSS 17.0 software. Base on 2-14 days follow-up CT scan, sensitivityand specificity of CT scan and CTP examination in diagnosis of AICVD were calculatedrespectively. Also, find out the most sensitive perfusion parameter. Testing the discrepanciesbetween ischemia side and contralateral side by paired t test. Testing the condition of cerebralfeeding artery stenosis and plaque between the ones who have normal perfusion and abnormalperfusion by chi-square test. Using Spearman rank correlation to analyse the correlation betweenthe degree of cerebral feeding artery stenosis and perfusion parameters.Results: 1. In 46 cases, 17 cases were showed lesions at the first cranial CT plain scan, 29cases were normal. 33 cases were revealed abnormal perfusion regions at CTP, of which, therewere 33 cases MTT maps, 30 cases on CBF maps, 20 cases on CBV maps. Other 13 casesshowed normal results at CTP, of which, 11 cases were confirmed by clinical follow-up astransient ischemic attacks (TIA), 1 case was lacunar infarction, 1 case was out of ROI. 2. Baseon 2-14 days follow-up CT scan (33 cases show lesions, 13 cases show normal which wereconfirmed as TIA), the sensitivity and specificity of CT plain scan in diagnosis of AICVD are51.5% and 100%, CBF maps are 89.7% and 92.3%, CBV maps are 60.6% and 100%, MTT maps are 93.9% and 84.6%. 3. In 33 cases with CTP abnormal patients, the CBF, CBV and MTT ofischemia side were (26.8±9.40)ml.100g-1.min-1, (2.37±1.03)ml.100g-1, (11.16±3.07)s, and that ofthe contralateral side were (48.51±16.08)ml.100g-1.min-1, (4.37±1.04) ml.100g-1, (6.70±1.79)s,they were significantly different. 4. In 33 cases with CTP abnormal patients, 25 cases have arterystenosis or occlusion (67 stenoses or occlusion), 39 were at intracranial arteries, 28 were atextracranial arteries. 29 cases were showed plaque (98 plaques), of which,42 were soft plaques,29 were calcified plaques, 27 were mixed plaques. Of 98 plaques, 34 were located at intracranialartery (9 were soft plaques, 15 were calcified plaques, 10 were mixed plaques), 64 were locatedat extracranial artery (33 were soft plaques, 14 were calcified plaques, 17 were mixed plaques)；In 13 cases with CTP normal patients, 5 cases have artery stenosis or occlusion (13 stenoses orocclusion), 3 were at intracranial arteries, 10 were at extracranial arteries. 6 cases were showedplaque (28 plaques), of which,4 were soft plaques, 17 were calcified plaques, 7 were mixedplaques. 5. The correlation between degree of cerebral feeding artery stenosis and hemodynamicchange showed that only the values of MTT and degree of artery stenosis had correlation(r=0.433), while the values of CBF, CBV had no significant correlation .Conclusio: 1. CTP can make definitive diagnosis of AICVD before morphologicalchanges. MTT is the most sensitive indicator. 2. The perfusion parameters exist differencebetween ischemia side and contralateral side. The valus of CBF, CBV were lower thancontralateral side, while the values of MTT were prolonged. 3. Stenosis or occlusion and plaqueformation of cerebral feeding artery were primary reasons for AICVD. The stenosis inintracranial arteriy was more often than in extracranial artery. Although the types of the plaquewere mainly soft plaques as a whole, calcified plaques were dominated in intracranial artery, softplaques were more in extracranial artery. 4. There is correlation between the values of MTT andthe degree of arteriy stenosis, while the values of CBF, CBV had no correlation. Therefor thecerebral hemodynamic changes cannot be completely predicted by degree of artery stenosis. 5.CTP combined with CTA could not only evaluate cerebral hemodynamics but show condition ofcorresponding feeding artery. They play an important role in diagnosis and treatment of AICVD.
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