The Values Of Energy Spectrum CT Whole Brain Perfusion Combined With Head And Neck CTA In Acute Ischemic Stroke

ObjectiveThe purpose of this study was to use energy spectrum CT CTP and head and neck CTA technology to accurately evaluate the cerebral tissue perfusion,collateral blood flow circulation and responsible vascular stenosis in patients with acute ischemic stroke.The prognosis of the patients was predicted by imaging examination and clinical follow-up.MethodsTo collect and analyze prospectively patients in June 2018-August 2019 in Henan province people’s hospital to receive the clinical suspicion of acute,subacute,39 cases of ischemic cerebral apoplexy patients,25 cases of male,female 14 cases,28-87-year-old age range.Inclusion criteria:(1)patients meeting the diagnostic criteria of cerebral infarction,whose clinical manifestations include varying degrees of confusion in speech and consciousness,numbness in one limb,paroxysmal vertigo,and shallow nasolabial canal on one side;(2)patients over 18 years old;Exclusion criteria:(1)ranial trauma,intracranial hemorrhage;(2)toxic diseases,post-seizure status(3)tumor stroke(4)encephalitis and somatic related serious dysfunction(5)impaired renal function/known hypersensitivity to contrast agents(6)MRI/CT contraindications.All patients received radiological examination within 24 hours.All patients received CT plain scan,CT perfusion,head and neck CT angiography,and MRI imaging examination were performed within 24 hours after CT examination(MRI examination was not performed immediately after multi-mode CT imaging,because this study focused on the value of ctp-head and neck CTA,and mri-dwi was only used for screening patients by reference).Of the 39 patients,28 underwent a CT plain follow-up about 13-34 days after the initial examination.All patients were followed up by clinic or telephone within 3 months to understand their clinical prognosis.Clinical data and medical history of all patients were collected,including gender,age,history of stroke,hypertension,diabetes,and smoking history(including smoking duration,daily dose,etc.).Ischemia in patients with all half dark belt,infarction area and the mirror surface corresponding to the contralateral area related to perfusion parameters measurement,including the CBF cerebral blood flow,cerebral blood volume CBV,average pass time determined by MTT,tmax TTP,etc.,for measuring the ischemia and half dark,infarction area and mirror parameter values corresponding to the contralateral areas for two grouping comparison and analysis,evaluation of cerebral perfusion status and brain activity,combined with the clinical analysis on prognosis;By combining head and neck CT angiography,the stenosis status and position of the responsible vessels were identified to evaluate the blood flow status and characteristics of collateral circulation.The prognosis of the patients was predicted by imaging examination and clinical follow-up.Results1.The sensitivity of whole-brain CT perfusion combined with head-neck CT angiography in the diagnosis of early ischemic stroke in this study were 94.44%,with specificity of 100%.2.The difference of parameters(CBF,CBV,MTT,TTP)between the infarct area and the healthy side area corresponding to the mirror was statistically significant(P<0.05).The difference in CBF,MTT and TTP between the penumbra and the healthy side of the mirror was statistically significant.The values of parameters(CBF,CBV,MTT,TTP)in the infarction core area and the penumbra area were significantly different(P<0.05).3.There was no statistically significant difference in CBF between the group with good collateral circulation and the group with poor collateral circulation(P>0.05),while there was statistically significant difference in CBV,MTT and TTP(P<0.05).The final volume of infarcts in the group with good collateral circulation was smaller than that in the group with poor collateral circulation(P<0.001),and the prognosis was better.4.In 28 patients who underwent imaging reexamination,the final size of infarction was correlated with the volume of abnormal perfusion area on CBV and CBF perfusion map(r=0.457,r=0.488),but had a poor correlation with the abnormal perfusion area of MTT and TTP.ConclusionThe whole brain CTP can distinguish the infarction area and penumbra area directly and accurately,and can predict the size of the final infarction in patients with acute ischemic stroke.Combined with head and neck CTA,it can clearly show the stenosis and occlusion of the corresponding arteries,accurately evaluate the collateral circulation status of brain tissue,guide the clinical treatment of acute ischemic stroke,and indicate the clinical prognosis.