基于CT灌注成像的pc-ASPECTS对椎基底动脉闭塞急性缺血性脑卒中预后的预测价值  

Prognostic value of pc-ASPECTS based on CT perfusion in patients with acute ischemic stroke caused by vertebral and basilar artery occlusion

作　　者：沈红健[1] 沈芳 尹伟[2] 邢鹏飞[1] 李子付[1] 张磊[1] 李强[1] 杨鹏飞[1] 张永巍[1] 刘建民[1] SHEN Hong-jian;SHEN Fang;YIN Wei;XING Peng-fei;LI Zi-fu;ZHANG Lei;LI Qiang;YANG Peng-fei;ZHANG Yong-wei;LIU Jian-min(Neurovascular Center,Changhai Hospital,Naval Medical University(Second Military Medical University),Shanghai 200433,China;Department of Radiology,Changhai Hospital,Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)长海医院脑血管病中心,上海200433 [2]海军军医大学(第二军医大学)长海医院放射诊断科,上海200433

出　　处：《第二军医大学学报》2022年第1期42-48,共7页Academic Journal of Second Military Medical University

基　　金：国家自然科学基金(82071278);上海市临床重点专科项目(shslczdzk06101)。

摘　　要：目的探讨基于脑计算机断层扫描灌注成像(CTP)的后循环Alberta脑卒中计划早期计算机断层扫描评分(pc-ASPECTS)对椎基底动脉闭塞急性缺血性脑卒中(VBAO-AIS)预后的预测价值。方法回顾性分析2019年1月至2020年12月在海军军医大学(第二军医大学)长海医院脑血管病中心接受血管内治疗的56例VBAO-AIS患者资料。所有患者急诊行多模态CT检查评估,获得基于非增强计算机断层扫描(NCCT)、CTP和RAPID-CTP的pc-ASPECTS。以治疗后3个月改良Rankin量表(mRS)评分作为预后评价指标(mRS评分≤3分为预后良好)。采用ROC曲线和多因素logistic回归分析评价基于NCCT与CTP、RAPID-CTP各参数的pc-ASPECTS对预后的预测价值。结果56例患者中预后良好组29例、预后不良组27例。预后良好组基于NCCT及CTP和RAPID-CTP各参数的pc-ASPECTS均高于预后不良组(P均<0.05)。基于CTP脑血容量(CBV)的pc-ASPECTS和基于RAPID-CBV的pc-ASPECTS预测预后的灵敏度分别为89.7%和79.3%,特异度分别为74.1%和81.5%,AUC值分别为0.861(95%CI 0.760~0.963)和0.861(95%CI 0.764~0.958)。二分类多因素logistic回归分析显示,基于NCCT的pc-ASPECTS≥8分、基于CTP CBV的pc-ASPECTS≥7分、基于CTP平均通过时间(MTT)的pc-ASPECTS≥5分、基于RAPID-CBV的pc-ASPECTS≥8分、基于RAPID-脑血流量(CBF)的pc-ASPECTS≥7分是预测VBAO-AIS患者血管内治疗后3个月预后良好的独立因素(P均<0.05)。结论基于CTP各参数的pc-ASPECTS是VBAO-AIS患者一个有用的预后指标,尤其是基于CBV的pc-ASPECTS对血管内治疗后3个月预后有较高的预测价值。Objective To explore the predictive value of posterior circulation-Alberta Stroke Program early computed tomography score(pc-ASPECTS)based on cerebral computed tomography perfusion(CTP)for prognosis of patients with acute ischemic stroke caused by vertebral and basilar artery occlusion(VBAO-AIS).Methods The data of56 patients with VBAO-AIS who received endovascular treatment in the Neurovascular Center,Changhai Hospital,Naval Medical University(Second Military Medical University)from Jan.2019 to Dec.2020 were retrospectively analyzed.All patients underwent emergency multimodal computed tomography(CT)examination,and the pc-ASPECTSs based on noncontrast computed tomography(NCCT),CTP and RAPID-CTP were obtained.The modified Rankin scale(m RS)score3 months after treatment was used to evaluate prognosis(m RS score≤3 indicated good prognosis).Receiver operating characteristic(ROC)curve and multivariate logistic regression analysis were used to evaluate the prognostic value of pc-ASPECTS based on NCCT and each parameter of CTP and RAPID-CTP.Results Among the 56 patients,29 had good prognosis and 27 had poor prognosis.The pc-ASPECTSs based on NCCT and each parameter of CTP and RAPID-CTP were significantly higher in the good prognosis group than those in the poor prognosis group(all P<0.05).The sensitivities of CTP cerebral blood volume(CBV)pc-ASPECTS and RAPID-CBV pc-ASPECTS in predicting prognosis were 89.7%and 79.3%,the specificities were 74.1%and 81.5%,and the area under curve values were 0.861(95%confidence interval[CI]0.760-0.963)and 0.861(95%CI 0.764-0.958),respectively.Binary multivariate logistic regression analysis showed that NCCT pc-ASPECTS≥8,CTP CBV pc-ASPECTS≥7,CTP mean transit time(MTT)pc-ASPECTS≥5,RAPID-CBV pc-ASPECTS≥8,and RAPID-cerebral blood flow(CBF)pc-ASPECTS≥7 were independent factors in predicting good prognosis of VBAO-AIS patients 3 months after endovascular treatment(all P<0.05).Conclusion pc-ASPECTS based on each parameter of CTP is a useful prognostic marker of VBAO-AIS patients.In

关 键 词：急性缺血性脑卒中 椎基底动脉闭塞 计算机断层扫描灌注成像 后循环 Alberta脑卒中计划早期计算机断层扫描评分 血管内治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]