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1 Chin J Radiol, October 2003, Vol 37, No. 10 CT CT 32 CT (regional cerebral blood flow, rcbf) (regional cerebral blood volume, rcbv) (mean transit time, M TT) (time2to2peak, TTP) ( / ),1 : TTP,M TT rcbf rcbv ; 2 : TTP M TT,rCBF,rCBV ; 1 : TTP M TT rcbf,rcbv ; 2 : TTP M TT,rCBF rcbv 1 4, CT TTP, M TT rcbf rcbv rcbf rcbv M TT TTP , TTP M TT,rCBF rcbv (8/ 13) rcbv (5/ 13) rcbf rcbv M TT TTP ,CT TTP M TT rcbf,rcbv (3/ 8) (5/ 8) rcbf rcbv M TT TTP , TTP M TT,rCBF rcbv rcbf rcbv M TT TTP CT CT,,, ; ;,X ; ; ; CT perfusion imaging and stages of regional cerebral hypoperfusion in pre2infarction period GA O Pei2 yi, L IN Yan. Depart ment of Neuroradiology, Beijing Neurosurgical Institute, Beijing , China Abstract Objective To investigate the applicative value in stages of pre2infarction period using dynamic perfusion CT. Methods Dynamic perfusion CT was performed in 32 cases of cerebral hypoperfusion. The ratios of side2to2side were measured at hypoperfusion areas in the regional cerebral ischemia. The stages of pre2infarction period were made as the following : ( 1 ) TTP was delayed, M TT, rcbf and rcbv were normal ; ( 2 ) TTP and M TT were delayed, rcbf was normal, and rcbv was normal or slightly increased ; ( 1 ) TTP and M TT were delayed, rcbf was decreased, and rcbv was normal or slightly decreased ; ( 2 ) TTP and M TT were delayed, rcbf and rcbv were decreased. Results There were 4 cases in stage 1. Regional hypoperfusion was revealed only by TTP map. The mean ratios of rcbf, rcbv, M TT, and TTP were 1. 00, 1. 00, 1. 00, and 1. 30, respectively. In stage 2, the areas of delayed TTP and M TT were found in all 13 cases. The rcbf and rcbv maps appeared normal in 8 cases. Another 5 cases showed normal rcbf and slightly increased rcbv areas. The mean ratios of rcbf, rcbv, M TT, and TTP were 1. 00, 1. 03, 1. 38, and 1. 30, respectively. In stage 1, the areas of delayed TTP and M TT were revealed in all 8 cases. The depiction of decreased rcbf was also found in 8 cases. The areas of decreased rcbv were showed in 5 cases, and normal rcbv maps were revealed in 3. The mean ratios of rcbf, rcbv, M TT, and TTP were 0. 56, 0. 94, 1. 49, and 1. 47, respectively. In stage 2, the areas of delayed TTP and M TT were revealed in all 4 cases, in whom depiction of decreased rcbf and rcbv was also found. The mean ratios of rcbf, rcbv, M TT, and TTP were 0. 42, 0. 59, 1. 57, and 1. 55, respectively. Conclusion CT perfusion imaging and its parametersanalysis may play an increasing role to delineate the depiction of cerebral hypoperfusion in pre2infarction period. Analyzing the : ( ) ; ( ) ( ) :100050

2 Chin J Radiol, October 2003, Vol 37, No relationship of rcbf, rcbv, M TT, and TTP is very helpful to know the status of the capillary vessels in regional cerebral hypoperfusion area and to provide functional information with our stages of pre2infarction period. Key words Perfusion, regional ; Cerebrovascular circulation ; Tomography, X2ray computed ; Brain ischemia ; Brain infarction ; Evaluation studies (cerebral blood flow, CBF) MR TOAST( Trial Org [3, in Acute Stroke Treatment ) ], 32 3 :, MR ; ( T 1 WI T 2 WI ) ;, CBF, 2 CT, CT CT CT ( TIA),, 1,, 10 mm, , kv ma [1, 2 ] CT : CT 32,, 1 s,, CT 40 s,40 (300 mg I/ L), 8 ml, 40 ml CT, CT [4 ], ( regional cerebral blood flow, rcbf) ( regional cerebral blood volume, rcbv) ( mean TIA, 24,4 ; 2270, transit time, M TT) ( time2to2peak, 47 1 TIA, TTP) 27 27,16 13, d ( rcbf,26 TIA,2 rcbv M TT TTP) : 2 TIA (ROI), rcbf 30 min 23, ;,30 min 1 h 4, 1 ROI, 24 h 24 ( / ),4 24,6,3 CT [1,4 ], :, 4,,, 4, (1) 1 : , 32 CT TTP,M TT rcbf rcbv (2) 2 :

3 Chin J Radiol, October 2003, Vol 37, No. 10 TTP Bayliss Bayliss M TT,rCBF,rCBV ( cerebral 2. :, CBF,, (1) 1 :CBF,, TTP M TT, rcbf, rcbv (2) 2 :, TTP M TT,rCBF rcbv circulation reserve, CCR) CBF 1 4,CT TTP, M TT rcbf rcbv ; 2 13, TTP M TT, rcbf rcbv (8/ 13) rcbv (5/ 13) ; 1 8,CT TTPM TT rcbf,rcbv (3/ 8) (5/ 1 CT 8) ; 2 4, TTP M TT,rCBF rcbv CT 1 3 CT 32 rcbf rcbv M TT TTP 2 1,,, 2 rcbf rcbv MTT TTP 25 %75 %,

4 Chin J Radiol, October 2003, Vol 37, No rcbf rcbv M TT TTP, ( / ) rcbf rcbv MTT TTP , TIA,,,CBF (, ) ; CBF,, rcbf rcbv ( ), 1 ( ), ( TOAST I ),, TTP,,,,,,, CBF, 3 :, ; rcbf rcbv CCR 2, CCR ;, CBF, rcbv rcbf CT, TTP, 2 (CBF = CBV/ M TT), M TT, CCR, CCR ;,rcbf,ccr,rcbf,rcbv,, 1,CBF, (misery perfusion), [1, ] TTP M TT rcbf,,rcbv 2, TIA, TIA [1, ] CT, TTP M TT, rcbf rcbv,, rcbf rcbv,rcbf rcbv, ;rcbf, rcbv,,,ct TTP,M TT rcbf rcbv, TIA CT, 2 1 TIA 2 TTP M TT rcbf rcbv rcbf rcbv, [9,10 ] [5211 ], 1 CT 4 ( rcbf rcbv

5 Chin J Radiol, October 2003, Vol 37, No. 10 M TT TTP), TTP Koenig [8 ] TTP 1,,, CT 2,,, TTP, CT TOAST I,,, TTP (2),I TTP < 1140, TTP > 1140 M TT.,2002,8 :125. [6,9 ], Grandin M TT, rcbf rcbv Rohl [10 ] M TT,M TT > 1163, 2 1 2,M TT, Rohl [10 ],M TT,, M TT, rcbf rcbv TTP M TT CCR TTP M TT CBF, CBV, Bayliss CCR rcbf rcbv, rcbf rcbv [12 ],rcbf CCR, 2 rcbv [1 ] 1,,. CT.,2003,37 : ,. TIA CT 3 Adams HP J r, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke : definitions for use in a multicenter clinical trial. TOAST. Trial Org in Acute Stroke Treatment. Stroke, 1993, 24 : ,. CT.,2002,36 : ,.., 2000,6 : Grandin CB, Duprez TP, Smith AM, et al. Which MR2derived perfusion parameters are the best predictors of infarct growth in hyperacute stroke? Comparative study between relative and quantitative measurements. Radiology, 2002, 223 : Hatazawa J, Shimosegawa E, Toyoshima H, et al. Cerebral blood volume in acute brain infarction : a combined study with dynamic susceptibility contrast MRI and 99m TC2HMPAO2SPECT. Stroke, 1999, 30 : Koenig M, Kraus M, Theek C, et al. Quantitative assessment of the ischemic brain by means of perfusion2related parameters derived from perfusion CT. Stroke, 2001, 32 : Grandin CB, Duprez TP, Smith AM, et al. Usefulness of magnetic resonance2derived quantitative measurements of cerebral blood flow and volume in prediction of infarct growth in hyperacute stroke. Stroke, 2001, 32 : Rohl L, Ostergaard L, Simonsen CZ, et al. Viability thresholds of ischemic penumbra of hyperacute stroke defined by perfusion2 weighted MRI and apparent diffusion coefficient. Stroke, 2001, 32 : Reichenbach J R, Rother J, Jonetz2Mentzel L, et al. Acute stroke evaluated by time2to2peak mapping during initial and early follow2up perfusion CT studies. AJ NR, 1999, 20 : Rovira A, Rovira2Gols A, Pedraza S, et al. Diffusion2weighted MR imaging in the acute phase of transient ischemic attacks. AJ NR, 2002, 23 : ( : ) ( : ) 5 000,400, ; 2 000, : CN / R, ISSN , 45 : ; CJ com, ( )