| Background and purpose:Thrombolytic therapy of acute cerebral infarction is an internationally recognized, can improve the outcome of ischemic stroke and effective treatment. 2010 China Guide diagnosis and treatment of acute ischemic stroke in the thrombolysis criteria, mainly in time of onset of ischemia involving the scope of the original image and the NIHSS score is based. Previous studies suggest that the value of the treatment of ischemic stroke is the way to save by thrombolysis infarction ischemic penumbra around. However, according to a simple time window and if there is no way to infer the existence of ischemic penumbra, and the guide mentioned that the 4.5-hour time window is still very short, most patients can not benefit。Moreover, as only the time window for thrombolytic condition, some patients even if there will be because the penumbra than the time window of thrombolytic therapy and the lack of effective treatment, some patients because there is no ischemia penumbra thrombolytic therapy been carried out, thereby increasing the risk of bleeding. Therefore, how to expand the time window in stroke patients and found the existence of ischemic penumbra to become the scholars cerebrovascular disease is an important topic. With the development of imaging, MRI or CT multi-mode applications for the onset of acute cerebral infarction than 4.5h, look there to save the ischemic penumbra of brain tissue can become a research hotspot.Currently, the international multi-modal MRI study more, and multi-mode CT study is relatively small, but multi-mode CT is more suitable for China. (1) multi-mode CT is more time-saving than the MRI. (2) CT examination costs were significantly lower than the MRI. (3) CT is a kind of popularity in China, the inspection equipment, and most hospitals 24h boot CT can be checked at any time. As in patients with normal CT scan does not find lesions on admission, but can not determine the existence of ischemic penumbra, however, perfusion CT but can do this. Therefore, some hospitals the diagnosis of acute ischemic stroke mainly depends on the parameters of CT perfusion maps, to identify infarction centers and ischemic penumbra. However, CT perfusion parametric maps need to have some experience in the acquisition of radiologists and patients during the CT scan led to the head of the Games, the software can not deal with the CTP parameter maps or parametric maps can not be interpreted. In this case, the analysis of perfusion CT images to determine the original center and infarction in patients with ischemic penumbra to become more meaningful, as long as you read the CT images, CT perfusion can quickly master the interpretation of the original image So that we can more easily determine if patients in the ischemic penumbra, to guide the next step in the treatment of patients.Methods: From February 2010 to July 2010 in Dalian between the Department of Neurology, the Third People's Hospital of acute stroke patients in hospital. Inclusion criteria: age 18-80 years; the U.S. National Institutes of Health Stroke Scale (NIHSS) score≥4 points; no history of stroke or modified Rankin score before the onset (mRs)≤2 points; anterior circulation ischemia. Exclusion criteria: intracranial hemorrhage and tumor; blood glucose <2.7mmol / L; or> 22.2 mmol / L; contrast agent allergy history and the history of renal insufficiency; image data incomplete; NIHSS score≥25 points.In all cases immediately after treatment routine head CT scan and brain perfusion imaging, the results will be dedicated to use perfusion CT image post-processing software, according to the mathematical model of local brain tissue blood perfusion, to observe the contrast agent within the capillary Concentration accurately calculate the image the following parameters: cerebral blood flow (CBF), blood volume (CBV), contrast agent mean transit time (MTT), reached a peak value of the contrast agent time (TTP), to perform a quantitative analysis.All patients were reviewed within 24 hours after the cerebral perfusion imaging. 7 days after the review of CT scan (noncontrast CT, NCCT). After all the images on-line classification of acute stroke Albert stroke program early CT score (ASPECTS score, minimum score of 0, maximum score is 10, the higher the score, the better the prognosis. get 0 points showed that the entire middle cerebral artery lesions Distribution of diffuse ischemia.)Evaluation of patients after admission NIHSS score, and the admission NIHSS score 7 days after the re-evaluation.Results:1.All 26 patients, by comparing the artery and vein of the original image of the existence of the original image mismatch (ie, penumbra), of which 19 patients with ischemic penumbra, 7 cases of ischemic penumbra was not found Band. Comparison of the existence of a mismatch parameter diagram, of which 19 patients with ischemic penumbra, 7 cases of ischemic penumbra was not found.2,.The arterial perfusion CT ASPECTS score closer to the original image cerebral blood flow (CBF) in the ASPECTS score, the correlation coefficient is 0.813. Venous phase of the ASPECTS score and cerebral blood volume (CBV) in the ASPECTS score, the correlation coefficient is 0.790. 24 hours of review of the arterial perfusion CT cerebral blood flow and the original image (CBF) in the ASPECTS score, the correlation coefficient is 0.825. Vein of the original image and the CT perfusion cerebral blood volume (CBV) of the correlation coefficient is 0.801. Artery instead of the original image can be represented infarction Center + CBF penumbra, venous CBV of the original image can replace the center to represent infarction.3.19 patients with ischemic penumbra of patients, 16 patients with thrombolytic therapy, 3 cases of conventional therapy. 16 cases of thrombolytic therapy in patients with ischemic penumbra narrowed in 11 patients, unchanged in 1 case, change the scope of ischemic penumbra great in 4 cases. Before thrombolysis compared with the NIHSS score after thrombolysis numerical increase in 1 case, 1 case of no change in lower values for 3 cases a lesser extent (≤2 points), a bigger drop in value in 11 cases (≥3 points), 68%.The conventional treatment of 3 patients, ischemic penumbra narrowing the scope of 2 cases, 1 case expanded the scope. Before thrombolysis compared with the NIHSS score in 1 case after thrombolysis in lower values for a minor (≤2 points), a bigger drop in value in 2 cases (≥3 points).4. There is no penumbra of the 7 patients after conventional treatment, 1 died, NIHSS score increase in 2 cases, NIHSS score remained unchanged in 2 cases, lower values for a minor (≤2 points) 1 Cases, a bigger drop in value (≥3 points) in 1.5.The incidence of≤4.5 hours there were 15 cases in the ischemic penumbra, accounting for 4.5 hours of onset in all patients within the 71%;> 4.5h,≤6h There are 3 cases of ischemic penumbra, Total time of onset between 4.5 to 6 hours in patients with 100%;> 6h,≤9 hours, 1 case of ischemic penumbra exists, accounting for 6-9 hours 50% of all patients.6.Vein of the original image and the CT scan after 7 ASPECTS score 23 cases consistent with the correlation coefficient was 0.901; CBV and CT scan after 7 ASPECTS score 22 cases consistent with a correlation coefficient of 0.872. 7. After treatment, 16 patients with revascularization, accounting for 58% of all patients, including thrombolysis in patients with complete recanalization in 7 cases, 6 had partial recanalization, 2 cases of patients without thrombolytic autolysis.Conclusion:Perfusion CT of the arterial and venous phase mismatch model of the original image can be used to determine the acute phase of stroke in patients with ischemic region to determine the ischemic penumbra and infarct center. Consistent with the parameter map can be used to guide the ischemic penumbra in patients with thrombolytic therapy, can narrow the range of ischemic penumbra, reducing infarct size and improve the final outcome of stroke patients. |
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