320排ct全脑灌注成像在tia诊断中的价值

Whole brain CT perfusion deficits using 320-detector-row CT scanner in TIA patients are associated with ABCD2 scoreInternational Journal of Neuroscience, 2014; 124(1): 5660Introduction01Methods02Results03Discussion04Conclusion05A transient ischemic attack (TIA) is considered a cerebral ischemic event without end organ damage or loss of brain tissue . Despite newer guidelines differentiating TIA from stroke, there remains controversy between a “time-based” and “tissue-based” definition of TIA . IntroductionResponsible blood vessels for internal carotid artery system of TIA patients mainly for hemiplegia, aphasia and partial body feels obstacle and so on.Responsibility for vertebral artery vessels system mainly displays in the patients with TIA vertigo, double vision, difficulty swallowing, etcBecause MRI diffusion weighted imaging information infers at least “potential infarction,” where tissue can no longer be saved, rather than ischemia, perfusion imaging either via MRI or CT is used to determine tissue at risk but not yet infracted, also known as penumbra. Perfusion modalities give a better representation of penumbra or tissue at risk but have not infarcted .01 A recent study has demonstrated that a significant portion TIA patients have perfusion changes using 64 detector row partial brain perfusion studies . Additionally, whole brain perfusion, using higher detector row CT scanners, has not been noted in the literature which could be more sensitive in determining the proportion of TIA patients that have perfusion abnormalities.02Currently, the ABCD2 score is used as a predictive tool to determine TIA patients who are at highest risk of stroke post-TIA. As the ABCD2 score determines immediate and 3-month stroke risk after TIA based on presenting symptoms, it provides an additional marker of potential stroke risk. CT perfusionOut positive weeks of intravenous injection of iodine contrast CT machine is used for continuous scanning of tissue or organ of interest area, measured time density curve by areas of interest, interested in computing area of perfusion parameters, such as cerebral blood flow, cerebral blood volume, average and tmax, over time, and can be applied at the same time the pseudo color map like visual display, using perfusion imaging to study the characteristics of tissue perfusion by cerebral perfusion images provided by the cerebral hemodynamic information, reflect the brain blood supply situation, evaluation of tissue and organ perfusion status.A age 01B blood pressure02C clinical features03D symptom duration04D diabetes 05ABCD2The perfusion changes in TIA patients ABCD2 score in TIA patients if they correlate ?Exclusion criteria312Subjects excluded were those that had positive MRI-DWI/ADC findings upon admission to the ER had a contraindication to contrast such as a history of contrast or iodine allergy.had no CT perfusion study done, had only transient sensory symptoms,01The study reviewed TIA patients for any CT perfusion deficits, including changes in CBV, TTP, CBF and MTT to determine, if a significant number of patients had a deficit despite resolution of symptoms.02Initially there were a total of 510 patients. Further inclusion criteria were that patients had a CT Head, CTA head and neck and CT perfusion study, and MRI brain was done after the CT but within 24 h. 03TIA patients who arrived to the hospital within 24 h of symptom onset of transient language, speech, or motor symptoms lasting less than 24 h; These criteria resulted in a total of 364 patients included in the study.MethodsPatient information collected included demographics (age, sex and race/ethnicity), clinical features: symptoms, number and duration of episodes, hospital admission blood pressure and calculated ABCD2 score .medical history .Radiographic features (computed tomography modalities including perfusion with whole brain parametric maps of MTT, CBV, TTP and CBF were obtained). ResultsOut of 364 TIA patients who underwent a CT perfusion study, 62 showed changes on CT perfusion.The largest group of patients had MCA territory involved with 48 of 62 patients. The second largest group was 11 patients with PCA territory or posterior fossa involved.Lastly, there were three patients with ACA territory involvement resulting in 4.83% of 62 patients.The most common perfusion abnormality was increased TTP. This was followed by increased MTT in 14 patients and change in CBF in 15 patients. Also, there were six patients with decreased CBV .An ABCD2 score greater than or equal to 3 was also associated with the presence of a CT perfusion deficitDuration of symptoms less than 10 min was significantly associated with not having a perfusion deficit present Presentation of TIA symptoms of aphasia or speech derangement and the presence of a CT perfusion abnormality. A statistically significant association was found between age 60Also motor weakness was not associated with perfusion deficit .History of diabetes and BP 140/90 were not associated with the presence of a perfusion deficit; but a was associated with a presenting systolic BP 180.ABCDEFDiscussionThe risk of stroke in patients with ABCD2 score greater than or equal to 4 is 9.8% and a score of 67 results in a risk of 17.8% at 90 d. It was thought that perfusion changes are rare in patients with TIA. With resolution of symptoms, ischemia is thought to be a reversible phenomenon. Our study was done using whole brain perfusion on a 320-detector-row CT scanner and confirms that CT perfusion deficits are moderately present in TIA patients.Although it may not indicate infarction, CT perfusion changes do indicate acute changes in hemodynamics, which can precede acute stroke changes seen on MRI. disadvantage Performed ABCD2 scores but our data were not subdivided per individual scorer to review any interrater variance.Another disadvantage to our study is that it is retrospective. Although patients with