摘要
目的:探讨头颅CT灌注成像(CTP)参数联合头颈CT血管造影(CTA)对急性缺血性脑卒中(AIS)侧支循环状态评估和预后预测价值。方法:回顾性纳入2018年6月至2023年6月于泰康仙林鼓楼医院就诊的AIS患者83例,入院后24 h内行CTP和头颈CTA检查。以数字减影-血管造影(DSA)检查结果为金标准,评估AIS患者侧支循环状态。收集患者一般资料,在患者AIS发生后90 d,通过电话或门诊随访,使用改良Rankin量表(mRS)评估患者的预后情况。皮尔逊(Pearson)或斯皮尔曼(Spearman)相关性分析侧支循环分级与CTP参数及头颈CTA评分的相关性。多因素Logistic回归分析CTP参数及头颈CTA评分对AIS患者预后预测的价值。受试者工作特征曲线(ROC)分析CTP参数、头颈CTA及联合对AIS患者预后的预测价值。结果:侧支循环良好组患者的脑血容量(CBV)、脑血流量(CBF)、CT血管造影(CTA)评分均高于侧支循环不良组,平均通过时间(MTT)、达峰时间(TTP)均低于侧支循环不良组(P<0.05)。CBV、CBF、CTA评分与AIS患者侧支循环状态呈负相关,MTT、TTP与AIS患者侧支循环状态呈正相关(P<0.05)。预后良好组患者的CBV、CBF、CTA评分均高于预后不良组,MTT、TTP均低于预后不良组(P<0.05)。多因素Logistic回归分析结果显示,MTT、TTP是AIS患者预后不良的危险因素,CBV、CBF、CTA评分是AIS患者预后不良的保护因素(P<0.05)。ROC结果显示,CBV、MTT、CBF、TTP、CTA评分及以上指标联合预测AIS患者预后的曲线下面积(AUC)为0.897、0.864、0.835、0.920、0.918、0.979;AUC比较结果显示,联合预测优于单独预测(Z=2.194、2.910、2.521、2.229、2.171,P<0.05)。结论:CTP参数联合CTA可有效评估AIS患者侧支循环,并且在预测患者预后中有重要价值。
Objective To explore the value of cranial CT perfusion imaging(CTP)parameters combined with head and neck CT angiography(CTA)in assessing collateral circulation status and predicting prognosis in acute ischemic stroke(AIS).Methods A retrospective analysis was carried out on 83 AIS patients who were treated in Taikang Xianlin Drum Tower Hospital from June 2018 to June 2023.CTP and head and neck CTA examinations were performed within 24 hours after admission.Digital subtraction angiography is the gold standard for assessing collateral circulation status in AIS patients.The general information of these patients was collected,and the patient's prognosis was evaluated using the modified Rankin scale through telephone or outpatient follow-up 90 days after the occurrence of AIS.Pearson or Spearman correlation was used to analyze the correlation between collateral circulation assessment and CTP parameters and head and neck CTA scores.The value of CTP parameters and head and neck CTA scores in predicting the prognosis of AIS patients was discussed using multivariate Logistic regression.Moreover,the receiver operating characteristic(ROC)curve was used to analyze the predictive value of CTP parameters,head and neck CTA,and the combination for the prognosis of AIS patients.Results The cerebral blood volume(CBV),cerebral blood flow(CBF),and CTA score were higher,while mean transit time(MTT)and time to peak(TTP)were shorter in the good collateral circulation group than in poor collateral circulation group(P<0.05).The collateral circulation status in AIS patients was negatively correlated with CBV,CBF,and CTA score,while positively correlated with MTT and TTP(P<0.05).Compared with poor prognosis group,good prognosis group had higher CBV,CBF,CTA,and shorter MTT and TTP(P<0.05).Multivariate Logistic regression analysis identified MTT and TTP as risk factors for poor prognosis,and CBV,CBF,and CTA scores as protective factors for poor prognosis in AIS patients(P<0.05).The ROC results showed that the area under the curve(AUC)of CBV,MTT,CBF,TTP,CTA score and the combination to predict the prognosis of AIS patients were 0.897,0.864,0.835,0.920,0.918,and 0.979,respectively,showing better predictive performance of the combination than single index alone(Z=2.194,2.910,2.521,2.229,2.171;P<0.05).Conclusion CTP parameters combined with CTA may effectively assess collateral circulation in patients with AIS and is significant for prognosis prediction.
作者
房海燕
葛亚莉
张宇辰
李丽环
高敏
FANG Haiyan;GE Yali;ZHANG Yuchen;LI Lihuan;GAO Min(Department of Radiology,Taikang Xianlin Drum Tower Hospital,Nanjing University School of Medicine,Nanjing 210023,China;Department of Radiology,Jiangsu Province Hospital of Chinese Medicine,Nanjing 210004,China)
出处
《中国医学物理学杂志》
2025年第7期911-917,共7页
Chinese Journal of Medical Physics
基金
江苏省重点研发计划一般项目(202282731)。
关键词
急性缺血性脑卒中
头颅灌注成像
头颈CT血管造影
侧支循环
预后
acute ischemic stroke
cranial perfusion imaging
head and neck CT angiography
collateral circulation
prognosis
