摘要
目的:探讨多时相CT血管成像(CTA)联合CT灌注成像(CTP)对短暂性脑缺血发作(TIA)患者进展为急性脑梗死(ACI)的预测价值。方法:回顾性分析选取2020年10月-2023年10月在本院收治的142例TIA患者,根据入院后7 d内是否发生ACI分为ACI组(n=35)和非ACI组(n=107);比较两组患者的一般临床资料、多时相CTA和CTP的参数;采用多因素Logistic回归方程分析影响TIA患者发生ACI的影响因素;绘制受试者工作特征(ROC)曲线评价多时相CTA联合CTP参数对TIA患者发生ACI的预测价值。结果:两组患者年龄、性别及有无冠心病、吸烟史、饮酒史情况比较,差异无统计学意义(P>0.05);ACI组合并高血压、糖尿病比例高于非ACI组,差异有统计学意义(P<0.05)。ACI组患者的血管狭窄程度[(84.61±10.46)%]高于非ACI组[(67.39±12.55)%],CBV[(2.36±0.51)mL/100 g]、CBF[(31.12±9.47)mL/min·100 g]低于非ACI组[(3.66±0.92)mL/100 g、(46.17±10.21)mL/min·100 g],Tmax[(12.67±4.75)s]、MTT[(6.89±2.16)s]高于非ACI组[(8.44±1.94)s、(4.39±1.56)s],差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示,合并高血压、糖尿病及高Tmax、MTT、血管狭窄程度均为影响TIA患者发生ACI的独立危险因素(P<0.05);高CBV、CBF均为影响TIA患者发生ACI的保护因素(P<0.05)。ROC曲线分析结果显示,CTP参数(Tmax、MTT、CBV、CBF)、CTA(血管狭窄程度)预测TIA患者发生ACI的AUC分别为0.857、0.814、0.865、0.916、0.816,联合预测的AUC为0.992(95%CI:0.960~0.999),灵敏度为97.29%,特异度为95.52%。结论:多时相CTA联合CTP对TIA患者进展为ACI具有较高预测价值,可作为临床评估的重要指标。
Objective:To explore the evaluation efficacy of multi-temporal CT angiography(CTA)combined with CT perfusion imaging(CTP)in patients with transient ischemic attack(TIA)progressing to acute cerebral infarction(ACI).Methods:A retrospective analysis was conducted on 142 TIA patients admitted to our hospital from October 2020 to October 2023.They were divided into ACI group(n=35)and non ACI group(n=107)based on whether ACI occurred within 7 days after admission.Compare the general clinical data,parameters of multi-temporal CTA and CTP between two groups of patients.Using Logistic regression analysis to identify the influencing factors of ACI in TIA patients.Draw receiver operating characteristic(ROC)curve and area under the curve(AUC)to evaluate the value of CTP parameters and CTA in assessing ACI in TIA patients.Results:There was no statistically significant difference in age,gender,and whether there was coronary heart disease,smoking history,or alcohol consumption history between the two groups of patients(P>0.05).The proportion of hypertension and diabetes in ACI group was higher than that in non ACI group,and the difference was statistically significant(P<0.05).The degree of vascular stenosis in the ACI group was(84.61±10.46)%,which was higher than that in the non ACI group(67.39±12.55)%.The CBV(2.36±0.51)mL/100 g and CBF(31.12±9.47)mL/min·100 g were lower than those in the non ACI group(3.66±0.92)mL/100 g and(46.17±10.21)mL/min·100 g .The Tmax(12.67±4.75)s and MTT(6.89±2.16)s were higher than those in the non ACI group(8.44±1.94)s and(4.39±1.56)s,with statistical significance(P<0.05).Multivariate logistic regression analysis showed that hypertension,diabetes,high Tmax,MTT and vascular stenosis were independent risk factors for the occurrence of ACI in TIA patients(P<0.05).High CBV and CBF are both protective factors affecting the occurrence of ACI in TIA patients(P<0.05).The ROC curve analysis results showed that the AUC of CTP parameters(Tmax,MTT,CBV,CBF)and CTA(degree of vascular stenosis)predicting the occurrence of ACI in TIA patients were 0.857,0.814,0.865,0.916,and 0.816,respectively.The AUC of combined prediction was 0.992(95%CI:0.960~0.999),with a sensitivity of 97.29%and a specificity of 95.52%.Conclusion:The combination of multi-temporal CTA and CTP exhibits high predictive value for TIA patients progressing to ACI and can serve as an important clinical assessment tool.
作者
陆凤明
姜亦伦
黄文磊
张士玉
王琪
LU Fengming;JIANG Yilun;HUANG Wenlei;ZHANG Shiyu;WANG Qi(Department of Imaging,Wuxi Branch,Zhongda Hospital Affiliated to Southeast University,Jiangsu 214000,China)
出处
《影像科学与光化学》
2025年第3期25-33,共9页
Imaging Science and Photochemistry
基金
江苏省卫生健康委科研项目(Z2019047)。
