全脑灌注联合多时相CT血管成像预测大脑中动脉M1段闭塞卒中患者出血转化  

Whole Brain Perfusion Combined with Multiphase CT Angiography in Predicting Hemorrhagic Transformation of Patients with M1 Segment Occlusion of Middle Cerebral Artery

作　　者：李翔 刘欢 熊秋霞 刘兴华[1] 杨染[1] 曾文兵[1] LI Xiang;LIU Huan;XIONG Qiuxia;LIU Xinghua;YANG Ran;ZENG Wenbing(Department of Radiology,Chongqing Three Gorges Central Hospital,Chongqing 404000,China;不详)

机构地区：[1]重庆三峡中心医院放射科,重庆404000 [2]通用电气药业有限公司,上海201203

出　　处：《中国医学影像学杂志》2020年第8期575-579,共5页Chinese Journal of Medical Imaging

摘　　要：目的探讨全脑灌注联合多时相CT血管成像(CTA)检查在预测缺血性脑卒中出血转化(HT)中的价值。资料与方法回顾性分析64例治疗前行一站式CT检查的缺血性卒中患者的临床资料,运用AW 4.7后处理工作站测量患侧与健侧灌注参数,包括脑血容量(CBV)、脑血流量(CBF)、达峰时间(TTP)、平均通过时间(MTT)、血流峰值时间(Tmax)和表面渗透性(PS),并计算相对脑血容量(rCBV)、相对脑血流量(rCBF)、相对达峰时间(rTTP)、相对平均通过时间(rMTT)、相对血流峰值时间(rTmax)和相对表面渗透性(rPS)。根据复查CT梗死灶内高密度影将患者分为出血组与未出血组,比较两组各灌注参数值的差异;通过多时相CTA对侧支循环进行评分,比较HT组间发生率的差异;绘制受试者工作特征曲线,分析P<0.05参数的诊断效能及与HT之间的相关性,比较不同治疗方式的出血发生率。结果出血组CBV小于未出血组,差异有统计学意义(P<0.05)。出血组患者TTP、MTT、Tmax、PS、rTTP、rMTT、rPS均大于未出血组,差异有统计学意义(P<0.05)。PS、rPS与HT呈正相关(r=0.628、0.516,P<0.001)。侧支不良组出血发生率(18/28,64.29%)高于侧支良好组(4/36,11.11%),差异有统计学意义(P<0.05)。灌注参数联合多时相CTA评分可提高诊断效能(曲线下面积0.891)。结论PS、rPS和多时相CTA评分对治疗前评估缺血性卒中患者HT风险具有重要价值。Purpose To explore the value of whole brain perfusion combined with multiphase CTA in predicting hemorrhagic transformation(HT)of ischemic stroke.Materials and Methods Sixty-four patients with ischemic stroke before treatment who underwent one-stop CT examination were included retrospectively.The perfusion parameters cerebral blood volume(CBV),cerebral blood flow(CBF),time to peak(TTP),mean transit timer(MTT),time to maximum(Tmax)and permeability surface(PS)were measured by post-processing software AW 4.7,and their ratios rCBV,rCBF,rTTP,rMTT,rTmax and rPS were calculated.The differences of perfusion parameters between HT group and non-HT group were compared.The collateral circulation score and hemorrhagic transformation rate were compared by the multiphase CTA.ROC curve was drawn to analyze the diagnostic efficiency of valuable parameters and the correlation with HT.The rate of HT in different treatments were also compared.Results CBV in the HT group was significantly lower than that in the non-HT group(P<0.05),while TTP,MTT,Tmax,PS,rTTP,rMTT and rPS in the HT group were statistically higher than those in the non-HT group(P<0.05).PS and rPS were positively correlated with HT(r=0.628 and 0.516,P<0.001).The HT rate in the poor collateral group(18/28,64.29%)was higher than that in the good collateral group(4/36,11.11%).Perfusion parameters combined with multiphase CTA score could improve the diagnostic efficiency(AUC=0.891).Conclusion PS,rPS and multiphase CTA scores have important value in assessing HT risk of ischemic stroke before treatment.

关 键 词：卒中 脑缺血 灌注成像 CT血管成像 侧支循环 出血转化 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.3[医药卫生—临床医学]