CT灌注成像课件

,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,反映组织的血管化程度及血流灌注情况，获得血液动力学方面的信息。,方法：快速造影剂团注后(5,ml/s,以上,),，在首次经过受检组织的过程中对某一选定的层面进行快速动态扫描，获得一系列动态图像，分析造影剂通过每个像素所对应的体素密度的差异，从而得到反映血流灌注情况的参数,。,CT,灌注成像(,Perfusion),1,反映组织的血管化程度及血流灌注情况，获得血液动力学方,脑梗塞,肝、肾血流灌注及肿瘤的诊断,肾移植的血流灌注的评价，了解移植血管的情况,电子束,CT,的灌注可了解心脏灌注，有助于缺血性心肌病的早期诊断,CT,Perfusion,应用,2,脑梗塞CT Perfusion应用2,由脑局部缺血而阻碍血液扩散是导致中风，占脑中风,70%,。用血纤维蛋白可溶解闭塞的血管。,发生中风后，有效治疗的时间为,3,小时左右。要尽快了解病情类型、发病时间和局部缺血的程度。,在这段时间内常规,CT,检查较难发现，而灌注,CT,可应用于急性中风检查。,CT,灌注,3,由脑局部缺血而阻碍血液扩散是导致中风，占脑中风70%,前动脉供血区,中动脉供血区,后动脉供血区,外则内侧底面,脑动脉系统,4,前动脉供血区中动脉供血区后动脉供血区外则内侧底面脑动,脑动脉系统,5,脑动脉系统5,在快速注射造影剂后，计算和脑的扩散有关的参数，从不同侧面提供中风的灌注分布情况：,脑血液流量,Cerebral Blood Flow,CBF,脑血液容量,Cerebral Blood Volume,CBV,造影剂达到各点最大值的时间,Time Peak,，,TP,平均通过时间,Mean transit time,，,MTT,通过,CBV,与,MTT,可获得,CBF,CT Perfusion,6,在快速注射造影剂后，计算和脑的扩散有关的参数，从不,常规,CT,通过组织对,X,线不同衰减来显示图像,CTA,通过造影剂在血管内流动来显示血管结构,灌注,CT,利用血液流动有关的参数,CBF,信号强示流速大；造影剂到达高峰的时间分布图,TP,，愈大意味着造影到达晚。,CBF,直接把它和向脑组织提供氧的总量联系起来，同时也与血液动力学方面有关。,CT Perfusion,7,常规CT通过组织对X线不同衰减来显示图像CT Perfus,紫色区域为血流量少,大脑急性中风区域,红色区域血流量大,CBF,8,紫色区域为血流量少,大脑急性中风区域红色区域血流量大CBF8,71,岁妇女在症状开始,90,分钟后进行检查。,CT,平扫示无反常情况，但,CBF,示脑左侧,(,中脑和左半动脉供血,),大部分，,(,前脑动脉,),提供地区严重局部缺血，示头颅内颈动脉的双枝闭塞。,CT Perfusion,9,71岁妇女在症状开始90分钟后进行检查。CT平扫示无反常情况,左半脑症状出现,60,分钟后，,CT,平扫无脑异常血液流动，,(b),示左侧半脑广泛性和右前部的局部缺血。,原因：左颈内动脉闭塞。,10,左半脑症状出现60分钟后，CT平扫无脑异常血液流动，(b)示,CBF CBV Time-to-peak image,男,44,岁右脑中风约,2,小时，,CBF,在脑岛的脑皮层和豆状核后部，示严重扩散障碍,(,接近零,),。与左边半球比较，中脑动脉血液供应相当少。,CBV,显示同样情况，但在右侧,MCA,其他地方血液容量接近正常。与左边区域比较，达到顶点时间图在延长,(,造影剂延迟到达,),。,MCA MI,段栓塞和小脑膜血液供应良好，,11,CBF,CBF Time-to-peak image 3,天后,CT,上述病例进行动脉血纤维蛋白溶解处理，治疗后一天，用扩散,CT,成像显示了治疗效果，,3,天以后,CT,平扫，示梗塞形成，,核心,区域与,CBF,和,CBV,图像相似。,12,CBF Time-to-p,在梗塞核心区域范围确定方面，,CT,灌注能提供重要信息，可绘局部缺血轮廓，用高密度来显示。,用于辨认梗塞灶核心和周围梗塞局部缺血,(,阴影,),，为外科提供治疗方法。,通常,CBV,的梗塞灶小于,CBF,和,TP,，,MRI,也如此，一般认为,CBV,提供的信息较正确。早期,CBV,减少 与随后梗塞形成程度较接近。,CT Perfusion,应用,13,在梗塞核心区域范围确定方面，CT灌注能提供重要信息，,与,CBV(b),相比,CBF(a),、,TP(c),在,MCA,中局部缺血间不匹配。,在脑岛脑皮层背部,(,箭,),有一梗塞灶。,再通治疗法后,24,小时,(d),在,MCA,同样位置示受限梗塞区。,14,与CBV(b)相比CBF(a)、TP(c)在MCA中局部,71-year-old female patient with right-sided hemiplegia(,偏瘫,)and global aphasia(,失语,).Plain CT(90 minutes later)reveals no early signs of an ischemia(,局部缺血,).,The parameter images display the entire extent of the ischemia with a high-grade reduction of CBF and CBV,a lacking detection of the contrast bolus in the time-to-peak image.,The infarction(,梗塞,)includes the region of the anterior cerebral artery and large portions of the region supplied by the middle cerebral artery,both features indicative of an occlusion of the intracranial carotid bifurcation.,Case 1,15,16,16,Patient(male 44)with a right-sided ischemia in the region of the middle cerebral artery(MCA)which began 160 minutes ago.Typical findings of a high-grade disturbance in perfusion in the insular cortex and the posterior portion of the lentiform nucleus with a reduction in CBF and CBV as a result of an embolic occlusion in the distal M1 segment.,The other regions supplied by the MCA demonstrated good leptomeningeal collateral blood supply which only showed moderately reduced CBF and CBV values,as well as a prolongation of the time-to-peak.,Case 2,17,Patient(male 44)with a right,In the calculation of relative perfusion indices from CBF values in ischemic areas and in mirrorred ROIs within the unaffected hemisphere proved to be a valuable method for the prognostic evaluation of a region with reduced perfusion.,The core of the infarct and the ischemic marginal zones demonstrate clearly different CBF perfusion indices(green-marked ROI=0.17 versus red-marked ROI=0.69).,18,In the calculation of relative,The findings of perfusion CT could be verified by DSA with regard to the type of occlusion and the condition of the collateral blood supply.,The follow-up CT after a successful intra-arterial fibrinolysis shows the infarct in dimensions comparable to the infarct core seen with perfusion CT.,19,The findings of perfusion CT c,70 minutes after the occurrence of the infarction,the CBF image revealed a highgrade ischemia in the frontal region of the supply area of the MCA and in the lentiform nucleus(Fig.3a)with a perfusion index in the greenmarked ROI of 0.07(Fig.3b).As a result of the good collateral flow,the disturbance in perfusion in the remaining region of the MCA,with a perfusion index of 0.82,is not seen to be very extensive(red-marked ROI in Fig.3b).,36-year-old male patient with an embolic occlusion in the M1 segment of the left MCA and a simultaneous occlusion of the left internal carotid artery as a result of dissection.,Case 3,20,70 minutes after the occurrenc,Because of the partially high-grade ischemia on the one hand and the excellent collateral blood supply of the marginal region on the other,fibrinolysis was not performed in spite of the short time interval.As expected,the follow-up CT revealed the development of an infarction in the area which had primarily demonstrated a high-grade ischemia.,21,Because of the partially high-,灌注,CT,与颅脑,CT,扫描和颅脑,CT,血管造影术结合为脑