Value of Whole Brain CTP Combined with Head and Neck CTA in the Diagnosis of Early AIS
Objective To explore the diagnostic value of whole brain CT perfusion imaging(CTP)combined with head and neck CT angiography(CTA)on early acute ischemic stroke(AIS).Methods 63 patients with suspected AIS in the hospital were selected as the study subjects.All patients underwent whole brain CTP examination,head and neck CTA examination and digital subtraction angiography(DSA)examination after admission.Using DSA examination as the gold standard,the value of DTP and CTA alone and in combination in diagnosing early AIS,CTP parameters[cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT),time to peak(TTP)]of infarct area and healthy brain tissue and the detection of head and carotid artery stenosis degree by CTA were analyzed.Spearman correlation analysis was used to analyze the correlation between CTP parameters and head and neck artery stenosis degree.Results CTP diagnosed 47 cases of positive AIS and 16 negative cases,and the diagnostic sensitivity,specificity,positive predictive value,negative predictive value,accuracy rate and Kappa value were 91.84％,85.71％,95.74％,75.00％,90.48％and 0.738.CTA diagnosis of AIS was positive in 46 cases and negative in 17 cases,and the sensitivity,specificity,positive predictive value,negative predictive value,accuracy rate and Kappa value of CTA were 87.76％,78.57％,93.48％,64.71％,85.71％and 0.616.CTP combined with CTA in the diagnosis of AIS showed that there were 48 positive cases and 15 negative cases,with diagnostic sensitivity of 95.92％,specificity of 92.86％,positive predictive value of 97.92％,negative predictive value of 86.67％,accuracy rate of 95.24％and Kappa value of 0.866.The combined diagnosis had higher value.The CBF and CBV in the abnormal perfusion area were significantly lower than those in the contralateral normal area(P＜0.05)while the MTT and TTP were significantly longer than those in the contralateral normal area(P＜0.05).A total of 107 sites of stenosis vessels were detected by DSA in 63 patients,including 22 sites of mild stenosis,46 sites of moderate stenosis,30 sites of severe stenosis and 9 sites of occlusion.CTA revealed 21 sites of mild stenosis,47 sites of moderate stenosis,31 sites of severe stenosis and 8 sites of occlusion,and the accuracy rates were 95.23％,89.36％,87.10％and 100％,and the total accuracy rate was 90.65％.The degree of artery stenosis detected by CTA was significantly negatively correlated with CBF and CBV(P＜0.05),and was significantly positively correlated with MTT and TTP(P＜0.05).Conclusion Whole brain CTP can effectively evaluate the brain tissue hemodynamic changes and ischemia severity while head and neck CTA can accurately detect the location and degree of cerebral artery stenosis.The combination of the two is of high value in the diagnosis of early AIS and can provide a reference for clinical disease diagnosis and treatment regimen selection.
CT Perfusion ImagingCT AngiographyAcute Ischemic StrokeArtery StenosisDiagnostic Value
NETL
NSTL
万方数据
维普
