目的 探讨动态四维CT血管造影 (four-dimensional CT angiography,4DCTA)联合全脑灌注成像(CT perfusion imaging,CTP)对缺血性脑卒中的诊断价 值。方法 对42例临床怀疑缺血性脑卒中 患者进行全脑灌注成像和常规头颅CTA 检查，通过灌注原始数据重建获得4DCTA，对图像质量、血管狭窄程度及灌 注参数等进行分析。结果 4D-CTA与常规 CTA的图像质量评分分别为(2.67±0.48) 和 ( 2 . 8 1± 0 . 3 9 )，差异无统计学意义 (P>0.05)。4D-CTA与常规CTA诊断血管狭 窄或闭塞结果一致，35例患者存在不同程 度的狭窄或闭塞。4D-CTA显示侧支循环 较常规CTA多2例，而且重度狭窄及闭塞 患者侧支循环显示率明显高于轻、中度 狭窄患者。CTP发现34例患者灌注异常， 8例灌注正常。CTA责任血管狭窄者CTP阳 性率(71.43%)明显高于无责任血管狭窄者 (9.52%)。结论 4D-CTA联合CTP不仅可用 于动态观察全脑血流状态，还能清晰显示 脑血管的异常变化，可以替代常规头颅 CTA检查，为临床提供更加丰富的影像学 信息。

Objective To explore the value of four-dimensional CT angiography combined with whole brain CT perfusion imaging in the diagnosis of ischemic stroke. Methods The whole brain CT perfusion imaging and conventional head CTA examination were performed in 42 patients with ischemic stroke. Meanwhile the whole brain plain images and 4D-CTA images were also generated from volumetric data acquired in the whole brain CTP. Images quality, vascular stenosis degree and CTP parameters were analyzed. Results The image quality ratings for 4D-CTA and the conventional CTA are (2.67±0.48) and (2.81±0.39) respectively. 4D-CTA and conventional CTA diagnosis of cerebral artery stenosis were not significantly different (P>0.05), and there was definite consistency. 4D-CTA found that the cerebral artery of 7 cases were normal, 35 cases had different degrees of stenosis or occlusion. 4D-CTA showed more collateral circulation than conventional CTA in 2 cases, moreover, the rate of collateral circulation in patients with severe stenosis and occlusion was significantly higher than that in patients with mild or moderate stenosis. CT perfusion imaging was positive in 34 patients and negative in 8 patients. The CTA vasoconstriction patients demonstrated a striking higher CTP positive rate compared with the ones without hemadostenosis. Conclusion 4D-CTA combined with CTP can not only monitor the cerebral hemodynamics conditions, but can also clearly demonstrate the changes of cerebral artery, which can replace the conventional CTA examination, and provide more comprehensive information for clinical treatment.