CT平扫联合脑CT灌注成像在前循环颅内大血管闭塞血管内治疗预后评价中的应用  

The value of combined non-contrast CT scan and cerebral CT perfusion imaging in prognosis evaluation of endovascular treatment for large vessel occlusion of anterior circulation

作　　者：杨梅[1] 孙艳秋[1] 白峻虎[1] 李耀东 张永海 张学栋 Mei Yang;Yan-qiu Sun;Jun-hu Bai;Yao-dong Li;Yong-hai Zhang;Xue-dong Zhang(Department of Imaging,Qinghai Provincial People's Hospital,Xining,Qinghai 810000,China;Department of Imaging,The Fifth People's Hospital of Qinghai Province,Xining,Qinghai 810007,China;Qinghai Province Cardiovascular and Cerebrovascular Disease Specialist Hospital,Xining,Qinghai 810012,China)

机构地区：[1]青海省人民医院影像科,青海西宁810000 [2]青海省第五人民医院影像科,青海西宁810007 [3]青海省心脑血管病专科医院,青海西宁810012

出　　处：《中国现代医学杂志》2021年第24期75-83,共9页China Journal of Modern Medicine

基　　金：青海省科技厅应用基础研究(No:2018-ZJ-704)。

摘　　要：目的探讨CT平扫联合脑CT灌注成像在前循环颅内大血管闭塞血管内治疗预后评价中的应用。方法回顾性分析2016年5月—2020年5月在青海省人民医院行血管内治疗的151例急性前循环颅内大血管闭塞患者的临床资料,根据改良Rankin量表(mRS)评分将患者分为预后良好组(mRS评分0~2分)75例和预后不良组(mRS评分3~6分)76例。所有患者入院后行头颅CT平扫联合脑CT灌注成像,记录影像学特征[CT平扫大脑中动脉高密度征(HMCAS)及CT灌注成像参数脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)],记录两组患者入院美国国立卫生研究院卒中量表(NIHSS)评分、Alberta卒中项目早期CT评分(ASPECTS)、急性卒中Org 10172治疗试验(TOAST)分型、侧支血流分级情况、术后即刻脑梗死溶栓(TICI)分级、术中及术后症状性颅内出血发生率等。采用多因素Logistic回归分析急性前循环颅内大血管闭塞患者血管内治疗临床预后的独立影响因素,评价头颅CT平扫中HMCAS和CT灌注成像参数在患者血管内治疗预后评价中的应用价值。结果预后良好组年龄、冠状动脉粥样硬化性心脏病病史、心房颤动、入院时NIHSS评分、MTTASPECTS评分、侧支循环分级0~2级比例、术后TICI分级<2b级比例、发病至血管再通时间、取栓次数、收缩压、HMCAS比例、MTT、TTP低于预后不良组(P<0.05);CBV-ASPECTS评分、CBF、CBV高于预后不良组(P<0.05)。两组性别、吸烟史、高血压、糖尿病、高脂血症、闭塞部位、TOAST卒中分型、桥接治疗、空腹血糖、舒张压、肌酐、白细胞计数比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,入院时NIHSS评分[OR=1.160(95%CI:1.019,1.321)]、CBV-ASPECTS评分[OR=1.789(95%CI:1.276,2.500)]、MTT-ASPECTS评分[OR=2.463(95%CI:1.431,4.239)]、侧支循环分级[OR=5.712(95%CI:1.669,19.549)]、发病至血管再通时间[OR=1.007(95%CI:1.002,1.012)]、收缩压[ORObjective To explore the value of combined non-contrast computed tomography(CT)scan and cerebral CT perfusion imaging in the prognosis evaluation of endovascular treatment for large vessel occlusion of anterior circulation.Methods The clinical data of 151 patients with acute large vessel occlusion of anterior circulation who received endovascular treatment in Qinghai Provincial People’s Hospital from May 2016 to May2020 were retrospectively analyzed.According to the modified Rankin Scale(MRS)score,the patients were divided into the good prognosis group(MRS score:0 to 2)of 75 cases and the poor prognosis group(MRS score:3 to 6)of76 cases.After admission,all patients received non-contrast CT scan combined with CT perfusion imaging,and the imaging parameters including hyperdense middle cerebral artery sign(HMCAS)in the non-contrast CT scan and cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT),and time to peak(TTP)in the cerebral CT perfusion imaging were recorded.The National Institutes of Health Stroke Scale(NIHSS)score at admission,Alberta Stroke Program Early CT Score(ASPECTS),Trial of ORG 10172 in Acute Stroke Treatment(TOAST)classification,collateral blood flow classification,immediate postoperative thrombolysis in cerebral infarction(TICI)classification,and intraoperative and postoperative incidence of symptomatic intracranial hemorrhage were detected.Multivariate Logistic regression was used to analyze the independent influencing factors for the clinical outcome after the endovascular treatment in patients with acute large vessel occlusion of anterior circulation.The application values of HMCAS in the non-contrast CT scan and the aforementioned CT perfusion imaging parameters in the prognosis evaluation of endovascular treatment for large vessel occlusion of anterior circulation were determined.Results The age,the proportion of patients with a history of coronary heart disease and atrial fibrillation,NIHSS score at admission,MTT-ASPECTS score,the proportion of grade 0 to 2 collatera

关 键 词：前循环颅内大血管闭塞 血管内治疗 预后 CT平扫 脑CT灌注成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学]