多模态成像技术在脑血管病中的应用与前景：以CT、MRI为核心的综合诊疗体系

Application and prospects of multimodal imaging techniques in cerebrovascular diseases: a comprehensive diagnostic and treatment system centered on computed tomography and magnetic resonance imaging

摘要:

多模态计算机体层成像（CT）与磁共振成像（MRI）技术是脑血管病诊疗的核心工具，整合结构、功能及代谢信息，为疾病诊治提供全方位支持。多模态CT含平扫CT、CT血管成像（CTA）及CT 灌注成像（CTP），扫描快速、普及率高。平扫CT可快速检出急性颅内出血，CTA精准识别大血管闭塞与动脉瘤，辅助血栓切除术决策，CTP通过血流动力学参数区分梗死核心与缺血半暗带，指导溶栓治疗。多模态MRI具有高软组织对比度、无辐射优势，包括弥散加权成像（DWI）、液体衰减反转恢复（FLAIR）等。DWI数分钟内检测早期缺血，FLAIR定量分析界定溶栓时间窗，磁共振血管成像（MRA）可清晰显示微小血管病变。CT和MRI两者联合应用可实现信息互补，显著提升急性缺血性卒中诊断准确率，为侧支循环评估、手术规划及预后预测提供关键依据。结合影像组学与人工智能，可进一步优化诊疗效率。此外，新型纳米探针、便携式MRI等技术创新，以及与血清生物标志物的联合应用，为脑血管病精准医疗开辟新方向，有望突破现有诊疗局限，改善患者预后。

Abstract:

Multi-modal computed tomography （CT） and magnetic resonance imaging （MRI） techniques are core tools for the diagnosis and treatment of cerebrovascular diseases， integrating structural， functional， and metabolic information to provide comprehensive support for disease diagnosis and treatment. Multi-modal CT techniques include non-contrast CT， CT angiography （CTA）， and CT perfusion imaging （CTP）， showing the advantages of rapid scanning and high penetration rate. NCCT can quickly detect acute intracranial hemorrhage， CTA accurately identifies large vessel occlusions and aneurysms and assists in decision-making for thrombectomy， and CTP distinguishes the infarct core from ischemic penumbra through hemodynamic parameters and thus provides guidance for thrombolytic therapy. Multi-modal MRI techniques include diffusion-weighted imaging （DWI） and fluid-attenuated inversion recovery （FLAIR） and have the advantages of high soft tissue contrast and procedures without radiation. DWI can detect early ischemia within minutes， FLAIR helps to define thrombolytic time window through quantitative analyses， and magnetic resonance angiography can clearly display microvascular lesions. The combination of CT and MRI provides complementary information， thereby significantly improving the diagnostic accuracy of acute ischemic stroke and providing key evidence for collateral circulation assessment， surgical planning， and prognosis prediction. The combination of radiomics and artificial intelligence can further optimize the efficiency of diagnosis and treatment. In addition， technological innovations， such as novel nanoprobes， portable MRI， and their combined application with serum biomarkers， open up new directions for precision medicine in cerebrovascular diseases， with the potential to break through the limitations of existing diagnosis and treatment and improve the prognosis of patients.