目的探讨多层螺旋CT(multislice spiral CT，MSCT)对超急性(0-6h) 大面积脑梗死的诊断及鉴别诊断价值。方 法 对我院近一年(2017年2月-2018年2月) 收治的临床怀疑有大面积脑梗死420例患 者在发病0-6h行头部CT平扫，随后(发病 12-24h、24-72h)行头部CT复查或其他临 床相关检查。比较患者超急性期CT检查结 果及临床最终确诊结果，分析评估MSCT 对超急性大面积脑梗死(发病0-6h)的诊断 价值。结果 发病0-6h内，MSCT检查诊断 为大面积脑梗死阳性病人208例，大面积 脑梗死阴性(如脑出血、腔隙性脑梗塞等) 病人212例，临床最终确诊为大面积脑梗 塞患者359例，MSCT检查对超急性期大面 积脑梗死诊断的敏感性、准确率、特异性 分别为57.9%、100.0%、64.0%；随着发病 时间延长，MSCT检查对大面积脑梗死疾病 的检出率明显增加，发病24h基本可检出 所有脑梗死。结论 超急性大面积脑梗死 的CT表现具有一定的特征性，虽然灵敏性 有待提高，但特异性高，且操作方便用时 短，可为急性重症患者赢取宝贵时间，可 用于诊断早期脑梗死。

Objective To investigate the diagnosis and differential value of multi-slice spiral CT in hyperacute (0-6h) massive cerebral infarction. Methods A total of 420 cases of patients who were highly suspected with massive cerebral infarction in our hospital during the past year (February 2017 to February 2018) were given head CT plain scan at the onset of 0-6 h, and were given head CT review or other clinical related examinations later (12-24 h and 24-72h of after onset). The CT examination results and the final clinical diagnosis results were compared, and the diagnostic value of MSCT in the diagnosis of hyperacute massive cerebral infarction (0-6h of onset) were analyzed. Results Within 0 to 6 hours of onset, there were 208 cases of massive cerebral infarction positive patients and 212 cases of massive cerebral infarction negative patients (such as cerebral hemorrhage, lacunar infarction, etc.) by MSCT, and 359 cases were eventually diagnosed as massive cerebral infarction by clinical diagnosis. The sensitivity, accuracy and specificity of MSCT in the diagnosis of hyperacute cerebral infarction were 57.9%, 100.0% and 64.0% respectively. With the prolongation of onset time, the detection rate of MSCT examination in massive cerebral infarction was significantly increased, and all cerebral infarctions were basically detected after 24h of onset. Conclusion Although the sensitivity of CT in the diagnosis of acute cerebral infarcion needs to be improved, the specificity is high and the operation is convenient. It can win precious time for the patients with acute severe cerebral infarction and can be used to diagnose early cerebral infarction.