目的 探究全脑CT灌注成像 (WBCTP)获得的CTP图像及动态血管成像 (4D-CTA)图像对脑血管狭窄或闭塞的评 估价值。方法 对我院神经外科收治的高 度怀疑有缺血性脑血管疾病(ICVD)的45 例患者行头部WBCTP及DSA检查，观察CTP 灌注参数[平均通过时间(MTT)、脑流量 (CBF)、脑血容量(CBV)]及4D-CTA图像中 脑血管狭窄和闭塞情况，并以DSA为参 照，分析CTP与4D-CTA在ICVD疾病中脑血 管狭窄或闭塞的诊断价值。结果 (1)DSA 检查结果显示45例患者确诊缺血性脑血管 疾病阳性42例，缺血性脑血管疾病阴性3 例，共检查了410支头颈部动脉，发现101 支脑供血动脉有狭窄或闭塞；(2)CTP灌 注图像示患侧脑组织MTT值显著大于健侧 (P<0.05)，CBF及CBV值均显著小于健侧 (P<0.05)；(3)4D-CTA图像示脑CTP灌注异 常患者脑血管狭窄或闭塞的检出率显著大 于脑CTP灌注正常患者(P<0.05)；(4)以 DSA检查结果为参照，WBCTP检查获得的 CTP图像结合4D-CTA图像判断脑血管狭窄 或闭塞的灵敏度、准确度、特异度分别 为89.11%(90/101)、97.09%(300/309)、 95.12%(390/410)。结论 CTP联合4D-CTA 能较准确诊断脑血管狭窄和闭塞的程度， 有助于临床制定合理的治疗方案，提高脑 血管疾病的治疗效果。

Objective To explore the evaluated value of CTP images and dynamic angiography (4D-CTA) images obtained by whole brain CT perfusion imaging (WBCTP) in the diagnosis of cerebrovascular stenosis or occlusion. Methods A total of 45 cases of patients who were highly suspected as ischemic cerebrovascular disease (ICVD) in department of neurosurgery of our hospital were given head WBCTP and DSA examination. The CTP perfusion parameters [mean transit time (MTT), cerebral blood flow (CBF), cerebral blood volume (CBV)] and cerebrovascular stenosis or occlusion in 4D-CTA images were observed, and DSA was taken as a reference to analyze the diagnostic value of CTP and 4D-CTA in cerebrovascular stenosis or occlusion in ICVD. Results DSA examination showed that 42 cases were diagnosed as positive ischemic cerebrovascular disease and 3 cases were negative ischemic cerebrovascular disease among 45 cases of patients, and a total of 410 head and neck arteries were examined and 101 cerebral arteries were found with stenosis or occlusion. CTP perfusion images showed that the MTT value of brain tissue of affected side was significantly larger than that of healthy side (P<0.05), and the CBF and CBV values were significantly smaller than those of healthy side (P<0.05). 4D-CTA images showed the detection rate of cerebrovascular stenosis or occlusion in patients with abnormal brain CTP perfusion was significantly greater than that of patients with normal brain CTP perfusion (P<0.05). Taken DSA results as references, the sensitivity, accuracy and specificity of CTP images combined with 4D-CTA images obtained by WBCTP were 89.11% (90/101), 97.09% (300/309) and 95.12% (390/410) respectively in judging cerebrovascular stenosis or occlusion. Conclusion CTP combined with 4D-CTA can accurately diagnose the degree of cerebrovascular stenosis and occlusion, and help to develop a reasonable treatment regimen and improve the treatment effects of cerebrovascular disease.