Automatic Post-Processing of Computed Tomography Perfusion for Patients with Acute Ischemic Stroke in Late Time Window: A Case Report

電腦斷層灌流檢查自動後處理分析應用於超過最佳治療期的急性缺血性腦中風病人－病例報告

林郁涵(Yu-Han Lin) ； 陳儀男(Yi-Nan Chen)

《中華放射線技術學雜誌》 45卷1期 (2021/03) Pp. 29-33

摘要

Approximately 30% of patients with acute ischemic stroke (AIS) arrive at the emergency room (ER) in the late time window in the United States. For patients with stroke, every minute counts. Computed tomography (CT) has been extensively used in the ER to evaluate patients with suspicion of AIS. CT perfusion (CTP) can compute clinical information to identify the infarct core and penumbra. Automatic post-processing of CTP not only improves the variability from different observers but also ensures the reproducibility of CTP compared with manual post-processing. It takes only a short time to generate a report indicating the volume and region of the infarct core and penumbra, which helps accelerate treatment decisions in the late time window. In this case report, a middle-aged male with AIS who visited our ER in the late time window underwent CTP. Perfusion maps analyzed by automatic post-processing software were obtained within minutes for the clinicians to make further treatment decisions. They revealed a large amount of mismatch volume and intra-arterial thrombectomy was performed afterward. CTP was arranged 10 hours after surgery, and the maps showed much less mismatch volume. Overall, automatic CTP post-processing provides rapid and objective clinical information for further decision-making for patients with AIS in the late time window.

關鍵字

acute ischemic stroke ； computed tomography perfusion ； automatic post-processing

並列摘要

在美國有大約30%中風的病人到急診求醫時症狀已經超過最佳治療時間，但對於中風的病人來說，每分每秒是非常珍貴的。目前電腦斷層檢查已經廣泛使用於疑似急性缺血性中風的病人，而電腦斷層灌流檢查可以分析出無法拯救的梗塞中心（infarct core）以及尚可挽回的區域（penumbra）。電腦斷層灌流檢查的自動後處理分析比起人工而言，不但可以改善不同使用者之間的變異性並且能確保檢查的再現性，利用自動後處理分析軟體可以在短時間內產生這些臨床資訊來加速決定後續的治療方針。本次的報告是一名疑似中風的中年男子來到急診時已經超過最佳治療期，完成腦部電腦斷層灌流檢查後，由自動後處理分析軟體產生的腦部灌流結果在數分鐘內提供給臨床醫師來決定後續的治療方式，從報告中顯示左側大腦有大量嚴重灌流不足之區域，立刻進行動脈內取栓術並在十小時後追蹤第二次電腦斷層灌流檢查，相較前次報告，灌流不足的區域有明顯減少的情形。總體而言，對於急性腦中風病人的後續治療方針，電腦斷層灌流檢查的自動後處理分析提供快速且更客觀的臨床資訊。

並列關鍵字

急性缺血性中風 ； 電腦斷層灌住檢查 ； 自動後處理分析