脑白质变性对急性缺血性卒中患者多模态CT评估的影响研究  

The impact of white matter lesion on multimodal CT for evaluating acute ischemic stroke

作　　者：戴益盛 苗重昌 顾艳 DAI Yisheng;MIAO Zhongchang;GU Yan(Xuzhou Medical University, Xuzhou 221000, China;Medical Imaging Department of Lianyungang Hospital, The Affiliated Hospital of Xuzhou Medical University, Lianyungang 222002, China)

机构地区：[1]徐州医科大学,江苏徐州221000 [2]徐州医科大学附属连云港医院影像科,江苏连云港222002

出　　处：《医学影像学杂志》2022年第5期726-730,共5页Journal of Medical Imaging

基　　金：江苏省卫生健康委科研课题(编号:H2018091)。

摘　　要：目的探讨脑白质变性(WML)对急性缺血性卒中患者多模态CT评估的影响。方法选取本院58例单侧颈内动脉末端或大脑中动脉M1段闭塞的患者临床及影像资料。患者于发病16h内行多模态CT检查。利用后处理工作站获得CTP灌注参数及4D-CTA图像,用ASTIN/SIR评分量表评估侧支循环。依据Fazekas量表评估患者WML的严重程度。动脉机械取栓术后48 h内行MRI检查,评估最终梗死体积。采用Spearman相关性分析探讨WML与侧支循环及CTP灌注参数之间的相关性。采用Wilcoxon对符号秩检验及Bland-Altman分析进行WML轻重组间预估梗死核心体积和最终梗死体积的差异性及一致性检验。结果急性缺血性卒中患者侧支循环与室周脑白质变性(pWML)的严重程度无关,而与深部脑白质变性(dWML)的严重程度负相关。预估梗死核心体积和最终梗死体积在WML轻度组无明显差异,而在重度组有明显差异。结论pWML、dWML与侧支循环的相关性存在差异;WML的严重程度会影响多模态CT对于急性缺血性卒中患者中能否受益于机械取栓术的评估,影响临床决策。Objective To investigate the impact of white matter of white matter lesion on multimodal CT for evaluating acute ischemic stroke.Methods The clinical and imaging data of 58 patients with unilateral middle cerebral artery or internal carotid artery occlusion were summarized restrospectively.All patients underwent multimodal CT examination within 16 hours after onset.White matter lesion(WML)was graded by the total Fazekas score,periventricular white matterlesion(pWML)and deep white matter change(dWML)scores,both ranging from 0 to 3.The collateral circulation was evaluated based on 4D-CTA using the modified ASITN/SIR collateral circulation scoring method,and the CT perfusion images were processed by the post-processing workstation to obtain perfusion parameters.The patient groups were divided into the good collateral circulation group and the poor collateral circulation group.According to the degree of WML,the two groups were categorized into mild group and severe group.Spearman rank correlation analysis was used to improve the correlation between WML and collateral circulation.Wilcoxon Rank-Sum test was used to compare the diversity of the volumn of infarct core and final infarct volume in the groups.Bland-Altman analysis was used to test their concordance.Results There was no evident association between pWML severity and collateral circulation.The dWML severity was negatively correlated with collateral circulation.On multivariate analysis,the dWML severity was independently associated with collateral status.The volumn of infarct core and final infarct volume differed notably in the severe groups.Conclusion In patients with acute ischemic stroke,collateral flow status does not seem to be influenced by increasing severity of pWML,but is associated with that of dWML.The extent of WML in patients with acute stroke eligible for mechanical thrombectomy impairs the accuracy of CTP maps for the prediction of tissue viability.

关 键 词：急性缺血性卒中 脑白质变性 侧支循环 体层摄影术 X线计算机 

分 类 号：R742[医药卫生—神经病学与精神病学] R814.42[医药卫生—临床医学]