CTP预测急性缺血性卒中患者脑动脉机械取栓术后对比剂外渗风险的初步研究  

Preliminary study on the prediction of contrast extravasation after mechanical thrombectomy in acute ischemic stroke using CT perfusion imaging

作　　者：王艳[1,2] 李倩文 郭道德[1,2] 杜祥颖 卢洁[1,2] WANG Yan;LI Qianwen;GUO Daode;DU Xiangying;LU Jie(Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing 100053, China)

机构地区：[1]首都医科大学宣武医院放射科,北京100053 [2]磁共振成像脑信息学,北京市重点实验室,北京100053

出　　处：《医学影像学杂志》2022年第7期1085-1089,共5页Journal of Medical Imaging

基　　金：北京市医院管理局“登峰”人才培养计划专项经费资助项目(编号:DFL20180802)。

摘　　要：目的通过评价急性缺血性卒中患者CT灌注成像病变区流量提取乘积(FED)和相对流量提取乘积(rFED)与脑动脉取栓术后对比剂外渗的相关性,探讨其对对比剂外渗风险的预测价值。方法选取责任血管为单侧大脑中动脉,行脑动脉机械取栓术成功再通的急性缺血性卒中患者,术前行CTP检查获得灌注参数FED、rFED(rFED等于患侧FED值/健侧FED值)。术后24 h内行双能头颅CT检查,按照结果分为无对比剂外渗组和对比剂外渗组。结果37例患者纳入分析观察,对比剂外渗组13例、无对比剂外渗组24例。无对比剂外渗组中位FED值为7.17 ml/100 ml×min,中位rFED值为3.83;外渗组中位FED值为8.94 ml/100 ml×min,中位rFED值为7.39,外渗组的中位FED、中位rFED值均高于无对比剂外渗组,二组间差异均有统计学意义(P<0.05)。ROC分析显示FED的cutoff值为6.32,敏感度为100%,特异度为46.0%;rFED的cutoff值为4.79,敏感度为84.6%,特异度为75.0%。结论rFED用于预测急性卒中患者动脉机械取栓术后发生对比剂外渗的准确性更高。Objective To explore the predictive value of flow extraction product(FED)and relative FED(rFED)on contrast extravasation after mechanical thrombectomy by evaluating the correlation of FED and rFED with post-procedure contrast extravasation in patients of acute ischemic stroke.Methods Consecutive patients of acute ischemic stroke(AIS)with unilateral middle cerebral artery as the criminal vessel,who underwent CT perfusion(CTP)imaging before mechanical thrombectomy and follow-up dual energy brain CT at 24 hours,were recruited.Lesion FED and rFED were measured on CTP maps.All cases were divided into extravasation and non-extravasation group according to dual energy CT appearances.The FED and rFED values were compared between the two groups.Results Totally,37 patients were included,including 13 cases with contrast extravasation and 24 cases without extravasation.The median FED and median rFED of the extravasation group were 8.94 ml/100 ml×min and 7.39,respectively.The median FED and median rFED were 7.17 ml/100 ml×min and 3.83,respectively.The FED and rFED of the extravasation group were significanty higher than those of the non-extravasation group(P<0.05).The sensitivity,specificity value were 100.0%,46.0%,with a cutoff value of 6.32 ml/100 ml×min.Those of rFED were 84.6%,75.0%,with a cutoff value of 4.79.Conclusion FED and rFED can be used to predict contrast extravasation after mechanical thrombectomy in patients of acute ischemic stroke,with higher accuracy provided by rFED.

关 键 词：脑卒中 毛细血管通透性 血管内治疗 对比剂外渗 体层摄影术 X线计算机 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R981.1[医药卫生—临床医学] R814.42