排C全脑灌注成像在IA诊断中的价值课件

WholebrainCTperfusiondeficitsusing320-detector-rowCTscannerinTIApatientsareassociatedwithABCD2scoreInternationalJournalofNeuroscience,2014;124(1):5660WholebrainCTperfusiondefic1Introduction01Methods02Results03Discussion04Conclusion05Introduction01Methods02Results2A transient ischemic attack(TIA)is considered a cerebralischemiceventwithoutendorgandamageorlossofbraintissue.Despite newer guidelines differentiating TIA from stroke,thereremains controversy between a“time-based”and“tissue-based”definitionofTIA.IntroductionAtransientischemicattack(T3ResponsiblebloodvesselsforinternalcarotidarterysystemofTIApatients mainly for hemiplegia,aphasia and partial body feelsobstacleandsoon.ResponsibilityforvertebralarteryvesselssystemmainlydisplaysinthepatientswithTIAvertigo,doublevision,difficultyswallowing,etcResponsiblebloodvesselsfor4排C全脑灌注成像在IA诊断中的价值课件5排C全脑灌注成像在IA诊断中的价值课件6TIA inspection methodTIA inspection method 1.BloodrheologyWholebloodviscosity,plasmaviscosity,hematocrit2.CerebrovascularCarotidultrasound、DSA、Cerebralperfusion3.CervicalcheckCervicalspineX-rayCTandMRI4.CTandMRIWiththeexceptionofhemorrhagicdisease。5.ElectrocardiogramToruleout:Frequentatrialfibrillation,prematurebeat,oldmyocardialinfarctionTIAinspectionmethod1.Blood7Severalpapersdemonstratethe presence of DWI/ADCchangesinpatientswithTIA.OtherscontendthatthesomewhatreversiblenatureofDWI/ADCchangesindicatesthatDWI/ADCmaynotbetheidealindicatorofendorgantissuedamage.However,recentevidencehasdemonstratedthattherecanbemorethanjustbrainischemiaoratleastsustainedischemiainvolvedinanacuteTIA,whichcomplicatestheideaofTIAwithoutdetectabletissuedamage.DWIarenotthebestSeveralpapersdemonstratethe8BecauseMRIdiffusionweightedimaginginformationinfersatleast“potentialinfarction,”where tissue can no longer be saved,rather than ischemia,perfusionimagingeitherviaMRIorCTisusedtodeterminetissueatriskbutnotyetinfracted,alsoknownaspenumbra.Perfusionmodalitiesgiveabetterrepresentationofpenumbraortissueatriskbuthavenotinfarcted.排C全脑灌注成像在IA诊断中的价值课件901ArecentstudyhasdemonstratedthatasignificantportionTIApatientshaveperfusionchangesusing64detectorrowpartialbrainperfusionstudies.Additionally,wholebrainperfusion,usinghigherdetectorrowCTscanners,hasnotbeennotedintheliteraturewhichcouldbemoresensitiveindeterminingtheproportionofTIApatientsthathaveperfusionabnormalities.02Currently,theABCD2scoreisusedasapredictivetooltodetermineTIApatientswhoareathighestriskofstrokepost-TIA.AstheABCD2scoredeterminesimmediateand3-monthstrokeriskafterTIAbasedonpresentingsymptoms,itprovidesanadditionalmarkerofpotentialstrokerisk.01Arecentstudyhasdemonstra10CTperfusionOutpositiveweeksofintravenousinjectionofiodinecontrastCTmachineisusedforcontinuousscanningoftissueororganofinterestarea,measuredtime density curve by areas of interest,interested in computing area ofperfusion parameters,such as cerebral blood flow,cerebral blood volume,averageandtmax,overtime,andcanbeappliedatthesametimethepseudocolor map like visual display,using perfusion imaging to study thecharacteristicsoftissueperfusionbycerebralperfusionimagesprovidedbythecerebralhemodynamicinformation,reflectthebrainbloodsupplysituation,evaluationoftissueandorganperfusionstatus.CTperfusionOutpositiveweeks11排C全脑灌注成像在IA诊断中的价值课件12排C全脑灌注成像在IA诊断中的价值课件13排C全脑灌注成像在IA诊断中的价值课件14Aage01Bbloodpressure02Cclinicalfeatures03Dsymptomduration04Ddiabetes05ABCD2A01B02C03D04D05ABCD215 TheperfusionchangesinTIApatients ABCD2scoreinTIApatientsiftheycorrelateTheperfusionchangesinTI16Exclusioncriteria312SubjectsexcludedwerethosethathadpositiveMRI-DWI/ADCfindingsuponadmissiontotheERhadacontraindicationtocontrastsuchasahistoryofcontrastoriodineallergy.hadnoCTperfusionstudydone,hadonlytransientsensorysymptoms,Exclusioncriteria312Subjec1701ThestudyreviewedTIApatientsforanyCTperfusiondeficits,includingchangesinCBV,TTP,CBFandMTTtodetermine,ifasignificantnumberofpatientshadadeficitdespiteresolutionofsymptoms.02Initiallytherewereatotalof510patients.FurtherinclusioncriteriawerethatpatientshadaCTHead,CTAheadandneckandCTperfusionstudy,andMRIbrainwasdoneaftertheCTbutwithin24h.03TIApatientswhoarrivedtothehospitalwithin24hofsymptomonsetoftransientlanguage,speech,ormotorsymptomslastinglessthan24h;Thesecriteriaresultedinatotalof364patientsincludedinthestudy.Methods01ThestudyreviewedTIApatie18Patient information collected included demographics(age,sexand race/ethnicity),clinical features:symptoms,number andduration of episodes,hospital admission blood pressure andcalculatedABCD2score.medicalhistory.Radiographicfeatures(computedtomographymodalitiesincludingperfusionwithwholebrainparametricmapsofMTT,CBV,TTPandCBFwereobtained).Patientinformationcollected19ResultsOutof364TIApatientswhounderwentaCTperfusionstudy,62showedchangesonCTperfusion.The largest group of patients had MCA territory involved with 48 of 62patients.The second largest group was 11 patients with PCA territory orposterior fossa involved.Lastly,there were three patients with ACA territoryinvolvementresultingin4.83%of62patients.The most common perfusion abnormality was increased TTP.This wasfollowedbyincreasedMTTin14patientsandchangeinCBFin15patients.Also,thereweresixpatientswithdecreasedCBV.ResultsOutof364TIApatients20AnABCD2scoregreaterthanorequalto3wasalsoassociatedwiththepresenceofaCTperfusiondeficitDuration of symptoms less than 10 min was significantlyassociatedwithnothavingaperfusiondeficitpresentPresentationofTIAsymptomsofaphasiaorspeechderangementandthepresenceofaCTperfusionabnormality.Astatisticallysignificantassociationwasfoundbetweenage60Alsomotorweaknesswasnotassociatedwithperfusiondeficit.HistoryofdiabetesandBP140/90werenotassociatedwiththepresence of a perfusion deficit;but a was associated with apresentingsystolicBP180.ABCDEFAnABCD2scoregreaterthanor21DiscussionTheriskofstrokeinpatientswithABCD2scoregreaterthanorequalto4is9.8%andascoreof67resultsinariskof17.8%at90d.ItwasthoughtthatperfusionchangesarerareinpatientswithTIA.Withresolutionofsymptoms,ischemiaisthoughttobeareversiblephenomenon.Ourstudywasdoneusingwholebrainperfusionona320-detector-rowCTscannerandconfirmsthatCTperfusiondeficitsaremoderatelypresentinTIApatients.Although it may not indicate infarction,CT perfusion changes doindicateacutechangesinhemodynamics,whichcanprecedeacutestrokechangesseenonMRI.DiscussionTheriskofstrokei22disadvantagePerformedABCD2scoresbutourdatawerenotsubdividedperindividualscorertoreviewanyinterratervariance.Anotherdisadvantagetoourstudyisthatitisretrospective.AlthoughpatientswithhigherABCD2scorestendedtobeadmittedtothehospital,therewerenoestablishedprotocolsastowhichTIApatientswereadmittedtothehospitalversusthosethatweredischargedhomeforoutpatientwork-up.PriorstudiesconfirmedthathigherABCD2scorecorrelatedwithtrueTIAsandincreasedrisk of stroke,but our institution at that time did not have any specificguidelinesastowhichABCD2scorewasthethresholdforadmissiondisadvantagePerformedABCD2s23提问与解答环节Questions And Answers提问与解答环节24谢谢聆听 学习就是为了达到一定目的而努力去干,是为一个目标去战胜各种困难的过程,这个过程会充满压力、痛苦和挫折Learning Is To Achieve A Certain Goal And Work Hard,Is A Process To Overcome Various Difficulties For A Goal谢谢聆听Learning Is To Achieve A C25