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Neurological Surgery No Shinkei Geka Volume 27, Issue 8 （August 1999）

Neurological Surgery 脳神経外科 27巻8号（1999年8月発行）

Japanese English

研究

DynamicCTを用いた急性期脳梗塞患者の予後予測 The Usefulness of Dynamic Computed Tomography Scanning in Predicting the Outcome of Acute Stroke Patients 長久公彦 ¹ , 森貴久 ¹ , 上田博弓 ² , 大畠義憲 ² , 曽我部紘一郎 ² , 森惟明 ¹ Kimihiko CHOKYU ¹ , Takahisa MORI ¹ , Hiromi UETA ² , Yoshinori OHATA ² , Koichiro SOGABE ² , Koreaki MORI ¹ ¹高知医科大学脳神経外科 ²中村市立市民病院脳神経外科 ¹Department of Neurosurgery, Kochi Medical School ²Department of Neurosurgery, Nakamura City Hospital キーワード： ischemic stroke , dynamic CT , outcome Keyword: ischemic stroke , dynamic CT , outcome pp.735-741

発行日 1999年8月10日 Published Date 1999/8/10

DOI https://doi.org/10.11477/mf.1436901764

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Abstract 文献概要
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I．はじめに

　脳血流を測定する方法にpositron emissiontomography（PET），single photon emissioncomputed tomography（SPECT），magnetic reso-nance imaging（MRI），Xe-CTなどがあるが，すべての施設で測定が可能なわけではない．したがって，脳血流を簡便に評価できる方法があれば，一般病院で急性期脳梗塞の治療を行う上で非常に役に立つ．そこで，CT装置があれば簡単に施行できるdynamic computed tomography（D-CT）^7）を用いて脳血流状態を推測できないかと考えた．CTで大きな低吸収域がまだ出現していない急性期脳梗塞患者に対してD-CTを施行し，その時間濃度曲線（time-density-curve：TDC）の特徴と予後との関係を調べることで，来院時TDCから予後を予測できないか検討した．

The aim of this study was to investigate whether brain dynamic computed tomography (CT) is useful inpredicting clinical outcome. Thirty patients suffering from cerebral ischemia in the territory of the middlecerebral artery (MCA) underwent dynamic CT scanning within 6 hours of stroke onset. Regions of in-terest (ROIs) were placed in the bilateral MCA territories and three parameters, peak value (PV), time topeak (TP), and PV divided by TP, were calculated from time-density curves (TDCs) on ROIs. After con-ventional treatment using pharmacological agents, the 30-day clinical outcome was evaluated on the Glas-gow outcome scale. To investigate the relationship between the disease-to-contralateral side ratio of eachparameter's value and 30-day clinical outcome, TDCs were classified into the following four types ; type 1,with TP ratio less than 1. 1 ; type 2, with TP ratio ranging from 1. 1 to 1.5 and PV/TP ratio more than0.75 ; type 3, with TP ratio ranging from 1. 1 to 1.5 and PV/TP ratio less than 0.75 ; and type 4, with TPratio more than 1.5 and PV/TP ratio less than 0.3. Clinical outcome in patients with type 1 or 2 TDC wasbetter than in patients with type 3 or 4 TDC (p＜ 0.01, Fisher's exact test). We can conclude that dynamicCT is a useful means for estimating the clinical prognosis of acute stroke patients after conventional treat-ment. Poor clinical outcome following conventional therapy is expected in patients with type 3 or 4 TDCin contrast to patients with type 1 or 2 TDC.