低剂量多时相CTA联合CTP评估急性缺血性脑梗死患者侧支循环及预后的应用价值  

Evaluation of Collateral Circulation and Prognosis in Patients with Acute Ischemic Cerebral Infarction by Low-Dose Multiphase CTA Combined with CTP

作　　者：曾焕忠[1] 邓明明[1] 冯战友 林菡[2] 方浩威[2] 陈伟[1] Zeng Huanzhong;Deng Mingming;Feng Zhanyou;Lin Han;Fang Haowei;Chen Wei(Department of Radiology,Houjie Hospital,Dongguan,Guangdong,523945;Department of Neurology,Houjie Hospital,Dongguan City,Dongguan 523945,Guangdong Province)

机构地区：[1]东莞市厚街医院放射科,广东东莞523945 [2]东莞市厚街医院神经内科,广东东莞523945

出　　处：《现代医用影像学》2019年第7期1459-1462,共4页Modern Medical Imageology

基　　金：东莞市社会科技发展(一般)项目,项目编号:201750715023201

摘　　要：目的:探讨低剂量多时相CTA联合CTP评估急性缺血性脑梗死患者侧支循环及预后的应用价值。方法:103例大脑中动脉狭窄或闭塞的缺血性脑梗死患者行低剂量多时相CTA和CTP检查,对其侧支循环进行评估并与90天后mRS评分对照,对比单时相与多时相CTA评价侧支循环的差异,比较单时相CTA、多时相CTA和CTP评价侧支循环与预后的一致性。结果:81例患者于90天后行影像学及临床随访复查,男59例,女22例,年龄29~91岁,中位年龄57岁,病变血管位于右侧45例,左侧36例。单时相CTA、多时相CTA和CTP分别评价侧支循环良好组为31例、48例、49例,侧支循环不良组为50例、33例、32例;单时相CTA与多时相CTA评价侧支循环的差异有统计学意义(P<0.05);90天后mRS评分预后良好53例,预后不良28例,单时相CTA vs预后、多时相CTA vs预后、CTP vs预后的Kappa值为0.355、0.712、0.660,多时相CTA和CTP评估侧支循环与预后的一致性均高于单时相CTA。结论:多时相CTA评估侧支循环及预后优于单时相CTA,低剂量多时相CTA联合CTP检查是评估急性缺血性脑梗死患者侧支循环的可靠及有效方法,有助于临床制定个性化治疗及评估预后。Objective:To investigate the value of low dose multiphase CTA combined with CTP in evaluating collateral circulation and prognosis in patients with acute ischemic cerebral infarction.Methods:One hundred and three patients with middle cerebral artery stenosis or occlusion were examined by low-dose multiphase CTA and CTP. The collateral circulation was evaluated and compared with the mRS score 90 days later. The differences between single-phase and multiphase CTA in evaluating collateral circulation were compared, and the consistency between single-phase CTA, multiphase CTA and CTP in evaluating collateral circulation and prognosis was compared.Results:Eighty-one patients underwent imaging and clinical follow-up 90 days later. Fifty-nine males and Twenty-two Female with age between 29 and 91 years(median age 57 years), The lesions were located on the right side in 45 cases and on the left side in 36 cases. Single-phase CTA, multiphase CTA and CTP evaluated good collateral circulation in 31 cases, 48 cases, 49 cases, and poor collateral circulation in 50 cases, 33 cases, 32 cases;There was significant difference between single-phase CTA and multiphase CTA in evaluating collateral circulation(P <0.05). 90 days later, 53 cases had good prognosis, 28 cases had poor prognosis, The Kappa values of single-phase CTA vs prognosis, multiphase CTA vs prognosis and CTP vs prognosis were 0.355, 0.712 and 0.660. The consistency of multiphase CTA and CTP in evaluating collateral circulation and prognosis was higher than that of single-phase CTA.Conclusion:Multiphase CTA is better than single-phase CTA in evaluating collateral circulation and prognosis. Low-dose multiphase CTA combined with CTP is a reliable and effective method for evaluating collateral circulation in patients with acute ischemic cerebral infarction. It is helpful for clinical personalized treatment and evaluation of prognosis.

关 键 词：多时相CTA CT灌注成像 缺血性卒中 侧支循环 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]