Perfusion CT of the brain using 40-mm-wide detector and toggling table technique for initial imaging of acute stroke
Perfusion CT of the brain using 40-mm-wide detector and toggling table technique for initial imaging of acute stroke
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DOI：
10.2214/ajr.07.2519
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发表时间：
2008-09-01
影响因子：
5
通讯作者：
Bae, Hee-Joon
中科院分区：
文献类型：
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作者：
Youn, Sung Won;Kim, Jae Hyoung;Bae, Hee-Joon
OBJECTIVE.脑在z轴上的有限覆盖是灌注CT的一个缺点。本研究的目的是评估在紧急临床环境中，在z轴上扩展覆盖的灌注CT对评估急性卒中的有用性。纳入了58例在卒中发作后24小时内接受80 mm覆盖灌注CT的患者。灌注CT使用64-MDCT单元，配备40 mm宽的探测器和切换台技术进行。以弥散加权成像和磁共振血管造影作为参考标准，分析灌注CT的病灶检测。通过提取在基底节水平获得的数据来模拟更传统的20 mm覆盖灌注CT，以与80 mm覆盖灌注CT进行比较。51例患者发生急性梗死，7例患者未发生急性梗死。对于80 mm覆盖的灌注CT，51例患者中有42例检测到灌注异常（敏感性，82.4%;特异性，85.7%）。当排除小动脉疾病（基底节、丘脑、放射冠和脑桥的小急性梗死）患者时，敏感性增加到92.3%。与80 mm覆盖的灌注CT相比，20 mm覆盖的灌注CT漏诊了9例位于基底节水平以上或以下的急性梗死（p = 0.0039）。80 mm覆盖的灌注CT被认为是急性缺血性卒中的初始成像方法，尽管它检测小的急性梗死的灵敏度较低。特别是，该技术比20 mm覆盖范围的灌注CT提供了更高的病变检测。
OBJECTIVE. Limited coverage of the brain in the z-axis has been a drawback of perfusion CT. The purpose of this study was to evaluate the usefulness of perfusion CT with extended coverage in the z-axis for the assessment of acute stroke in an emergent clinical setting.MATERIALS AND METHODS. Fifty-eight patients who underwent 80-mm-coverage perfusion CT within 24 hours after stroke onset were included. Perfusion CT was performed using a 64-MDCT unit equipped with 40-mm-wide detector and the toggling table technique. Lesion detection by perfusion CT was analyzed using follow-up diffusion-weighted imaging and MR angiography as the reference standards. More conventional 20-mm-coverage perfusion CT was simulated by extracting data obtained at the basal ganglia level for comparison with 80-mm-coverage perfusion CT.RESULTS. Fifty-one patients had acute infarctions and seven patients did not. For 80-mm-coverage perfusion CT, perfusion abnormality was detected in 42 of 51 patients (sensitivity, 82.4%; and specificity, 85.7%). When patients with small artery disease (small acute infarctions in the basal ganglia, thalamus, corona radiata, and pons) were excluded, sensitivity increased to 92.3%. As compared with 80-mm-coverage perfusion CT, 20-mm-coverage perfusion CT missed nine acute infarctions located above or below the level of the basal ganglia (p = 0.0039).CONCLUSION. Perfusion CT with 80-mm-coverage was found to be useful as an initial imaging method in acute ischemic stroke, although it had low sensitivity for detecting small acute infarctions. In particular, this technique provided higher lesion detection than 20-mm-coverage perfusion CT.