The application value of dual-layer detector spectral CT angiography in evaluation of brain perfusion in patients with acute ischemic stroke / 中华放射学杂志

Objective:To explore the clinical application value of the dual-layer detector spectral CTA in evaluation of brain perfusion impairment in patients with acute ischemic stroke.Methods:Clinical and imaging data of 35 patients with acute ischemic stroke in Weihai Central Hospital from March 2020 to October 2020 were reviewed retrospectively. All patients underwent head and neck spectral CTA examination and dynamic cerebral perfusion CT examination with dual-layer detector spectral CT. The iodine density map and effective atomic number map were reconstructed using CTA data, and the iodine density and effective atomic number, as well as the cerebral blood volume (CBV) and cerebral blood flow (CBF) values of the hypoperfusion area and the contralateral side were measured and compared; the areas of brain hypoperfusion regions were measured. Pearson′s correlation coefficient was used to analyze the correlation between iodine density values and CBV values, iodine density values and CBF values, effective atomic number values and CBV values, effective atomic number values and CBF values, as well as hypoperfusion area shown on CTA images and displayed on CTP-CBF map.Results:Of all the 35 patients, the iodine density value [(0.22±0.07) mg/ml], effective atomic number value (7.38±0.05), CBV value [(1.9±0.7) ml/100 g] and CBF value [(15.1±5.9) ml/(100 g·min)] of the hypoperfusion area were significantly lower than those of the healthy side [iodine density value (0.44±0.10) mg/ml, effective atomic number value (7.52±0.06), CBV value (3.4±0.7) ml/100 g, CBF value (57±27) ml/(100 g·min); t values were -14.7, -14.5, -11.2, -9.7, respectively, all P<0.001]. No significant difference was found between the hypoperfusion area shown on spectral CTA [(2 292±1 393) mm 2] and shown on CTP-CBF map [(2 290±1 359) mm 2] ( t=-0.076, P=0.944). There was a positive correlation between iodine density value and CBV (affected side: r=0.350, P=0.039, healthy side: r=0.551, P=0.001); a positive correlation was also found between effective atomic number value and CBV (affected side: r=0.488, P=0.003, healthy side: r=0.552, P=0.001); and there was a strong positive correlation between the hypoperfusion area on CTA and that on CTP-CBF ( r=0.993, P<0.001). Conclusion:Dual-layer detector spectral CTA can provide the “one-stop” assessement including head and neck vascular evaluation, as well as the hypoperfution area measument, which can be an alternative rapid method for evaluation of patients with acute ischemic stroke.

Analysis of the significance of cerebral perfusion imaging combined with CT angiography in the diagnosis and treatment plan of patients with ischemic stroke / 中国医师进修杂志

investigate the significance of cerebral perfusion imaging combined with CT angiography (CTA) in the diagnosis and treatment plan of patients with ischemic stroke. Methods Total of 44 patients with acute cerebral infarction were enrolled in Taizhou First People′s Hospital from January 2018 to September 2018. Cerebral perfusion imaging and CTA examination were performed simultaneously within 12 h after the onset of the disease. The images of perfusion imaging were processed using an image workstation to measure the level of perfusion parameters in the ischemic region of the patient′s brain. The head and neck of the patient were measured by CTA. The angiography was performed, and the cerebral angiography results of all patients were as the gold standard. The clinical diagnosis and diagnostic efficacy of different examination methods in patients with ischemic stroke was observed and compared, and the differences in the parameters of perfusion imaging between different perfusion abnormal areas and normal control areas were compared. Results When patients′ cerebral angiography and single-photon emission computed tomography (SPECT) was as the gold standard for comparison, cerebral blood flow (CBF) and mean transit time (MTT) had the highest accuracy among all parameters of perfusion imaging. The accuracy rate of perfusion imaging +CTA was 93.2% , with a specificity of 100.0% and a sensitivity of 90.1%, which was significantly higher than that of the clinical efficacy of single diagnosis. Conclusions Perfusion imaging combined with CTA can provide important supplementary reference information for clinical diagnosis and treatment of patients with ischemic stroke.

Analysis of the significance of cerebral perfusion imaging combined with CT angiography in the diagnosis and treatment plan of patients with ischemic stroke / 中国医师进修杂志

Objective@#To investigate the significance of cerebral perfusion imaging combined with CT angiography (CTA) in the diagnosis and treatment plan of patients with ischemic stroke.@*Methods@#Total of 44 patients with acute cerebral infarction were enrolled in Taizhou First People′s Hospital from January 2018 to September 2018. Cerebral perfusion imaging and CTA examination were performed simultaneously within 12 h after the onset of the disease. The images of perfusion imaging were processed using an image workstation to measure the level of perfusion parameters in the ischemic region of the patient′s brain. The head and neck of the patient were measured by CTA. The angiography was performed, and the cerebral angiography results of all patients were as the gold standard. The clinical diagnosis and diagnostic efficacy of different examination methods in patients with ischemic stroke was observed and compared, and the differences in the parameters of perfusion imaging between different perfusion abnormal areas and normal control areas were compared.@*Results@#When patients′ cerebral angiography and single-photon emission computed tomography (SPECT) was as the gold standard for comparison, cerebral blood flow (CBF) and mean transit time (MTT) had the highest accuracy among all parameters of perfusion imaging. The accuracy rate of perfusion imaging+CTA was 93.2%, with a specificity of 100.0% and a sensitivity of 90.1%, which was significantly higher than that of the clinical efficacy of single diagnosis.@*Conclusions@#Perfusion imaging combined with CTA can provide important supplementary reference information for clinical diagnosis and treatment of patients with ischemic stroke.

Application of mechanical thrombectomy in the patients with wake-up stroke / 上海交通大学学报（医学版）

Wake-up stroke (WUS), which is characterized by the uncertain onset time and poor short-term outcome, accounts for 25% of stroke. Due to the above two points, how to choose the treatment methods remains to be researched. The mechanical thrombectomy is the first-line treatment of acute ischemic stroke (AIS). DAWN and DEFUSE-3 studies have recently demonstrated that the treatment window can be expanded to 24 hours, so the endovascular treatment may be effective and safe in some WUS patients according to the existence of "the mismatch of clinical score and imaging infart core" by CT perfusion imaging and other modern imaging methods. This article summarized the application of mechanical thrombectomy in WUS treatment in recent years.