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不同阶段缺血性脑梗塞CT影像学特点

作者:张 志 白 琛 骆 伟

所属单位:成都医学院第一附属医院放射科 (四川 成都 610500)

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摘要

目的 探讨不同阶段缺血性脑梗 塞CT影像学特点。方法 回顾性分析发病 1-48h经临床确诊为缺血性脑梗塞患者57 例的临床资料,入院时行首次CT检查, 间隔24 h复查,分析CT影像学表现。结 果 本组57例患者,首次CT诊断发现28例 异常(49.12%),24h后复查发现43例异常 (75.44%),以大脑中动脉供血区堵塞为 主。4例发病时间<6h,CT平扫无法清晰 显示显示病灶,小部分患者脑会沟轻微 变窄;16例发病时间6-24h,脑沟消失, 灰白质无清晰边界,脑沟有不同程度的 变浅;23例发病时间>24 h,病灶处为大 中动脉为高密度,轻微占位现象,脑回 不对称,部分中线结构改变,豆状核边 缘不清晰,脑灰质密度降低,脑白质无 清晰界线。结论 不同阶段CT影像学表现 不同,临床医师应提高对CT影像阳性特 点的认识。

Objective To investigate the CT imaging findings of different stages of ischemic cerebral infarction. Methods The clinical data of 57 patients with ischemic cerebral infarction clinically confirmed in 1~48h after attack were retrospectively analyzed. All patients were examined by CT and were reexamined every 24h. CT imaging findings were analyzed. Results Among 57 patients in this study, the first CT diagnosis found that 28 cases were abnormal (49.12%). 24h later, reexamination found that 43 cases were abnormal (75.44%), mainly was blockage in blood supply area of cerebral middle artery. There were 4 cases whose onset time was shorter than 6h and CT scan can not clearly show the lesions. Small part of the patients were with slight narrowing of cerebral sulci, The cerebral sulci of 16 patient whose onset time was 6~24h disappeared and the gray matter had no clear boundary. Cerebral sulci had different degrees of shallowing; The onset time of 23 patients were longer than 24h. Large and medium sized arteries in lesions showed high density and there was slight occupying phenomenon. Gyri was asymmetric and part of the midline structures changed. The edges of lentiform nucleus were not clear and the density of brain gray matter decreased and brain white matter were without clear boundaries. Conclusion CT imaging findings in different stages are different. Clinicians should improve the recognition of the positive characteristics of CT imaging.

【关键词】缺血性脑梗死;CT;影像学;发病时间

【中图分类号】R445.3;R743

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.05.002

前言

缺血性脑梗死是临床常见的脑血管疾病类型,与脑供血障碍造成 脑组织缺血、缺氧等有关。早期给予溶栓治疗,能有效控制疾病发 展,降低残疾率和死亡率,改善预后[1]。CT具有操作简便、经济的特 点,是临床诊断缺血性脑梗死可靠的影像学方法,对临床早期溶栓治 疗具有指导意义[2]。目前,临床关于CT诊断缺血性脑梗准确率的报道 较多,但关于不同阶段缺血性脑梗死的CT影像学表现的报道相对较 少。对此,本文分析了发病1~48h且经临床确诊为缺血性脑梗塞患者 的CT影像学表现,探讨CT在诊断早期治疗缺血性脑梗死中的应用价 值,现报道如下。