目的 探讨急性脑梗死患者应用 256层多层螺旋CT(MSCT)行全脑CT灌注成 像(CTP)与CT血管造影(CTA)检查的诊断 价值。方法 回顾性分析2016年6月-2018 年6月我院收治的48例急性脑梗死患者的 临床资料。患者均接受256层MSCT检查， 包括全脑CTP和CTA。比较梗死区与对侧镜 像区脑灌注参数[脑血流量(CBF)、局部血 容量(CBV)、平均通过时间(MTT)、达峰时 间(TTP)]，记录头颈部动脉狭窄和闭塞情 况。结果 CTP检查发现48例患者均存在 与临床症状相符的脑灌注异常区，梗死 区CBF、CBV水平低于对侧镜像区，MTT、 TTP长于对侧镜像区(P﹤0.05)；CTA检查 发现48例患者存在血管病变56处，其中 轻度狭窄11处(19.64%)，中度狭窄21处 (37.50%)，重度狭窄18处(32.14%)，完全 闭塞6处(10.71%)。结论 256层MSCT全脑 CTP联合CTA检查可准确判断脑梗死区域和 对应的血流动力学改变，明确血管狭窄部 位和程度，对急性脑梗死有较高的临床诊 断价值。 【关键词】急

Objective To explore the diagnostic value of whole brain CT perfusion imaging (CTP) and CT angiography (CTA) of 256-slice multi-slice spiral CT (MSCT) in patients with acute cerebral infarction. Methods The clinical data of 48 patients with acute cerebral infarction admitted to our hospital from June 2016 to June 2018 were analyzed retrospectively. Patients were given 256-slice MSCT examinations, including whole brain CTP and CTA. The cerebral perfusion parameters [cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP)] in the infarct areas and contralateral mirror imaging areas were compared, and the head and neck artery stenosis and occlusion were recorded. Results CTP examination showed that 48 patients had cerebral perfusion abnormal areas which were consistent with clinical symptoms, and the levels of CBF and CBV in infarct areas were lower than those in contralateral mirror imaging areas, and the MTT and TTP were longer than those in contralateral mirror imaging areas (P<0.05). CTA examination found there were 56 vascular lesions among 48 patients, including 11 cases of mild stenosis (19.64%), 21 cases of moderate stenosis (37.50%), 18 cases of severe stenosis (32.14%) and 6 cases of complete occlusion (10.71%). Conclusion 256-slice MSCT of whole brain CTP combined with CTA can accurately determine the cerebral infarction areas and corresponding hemodynamic changes, and determine the location and extent of vascular stenosis, and has high clinical diagnostic value for acute cerebral infarction.