脑灌注相对参数预测急性前循环大血管闭塞性脑卒中经机械取栓后出血转化的价值  

Value of cerebral perfusion relative parameters in predicting hemorrhagic transformation after mechanical thrombectomy in acute anterior circulation large vessel occlusive stroke

作　　者：戴国娇 郑永飞[1] 陈运奎 徐程华 黄丹江[1] DAI Guojiao;ZHENG Yongfei;CHEN Yunkui;XU Chenghua;HUANG Danjiang(Department of Radiology,Taizhou First People’s Hospital,Taizhou 318020,Zhejiang,China;Department of Neurology,Taizhou First People’s Hospital,Taizhou 318020,Zhejiang,China)

机构地区：[1]台州市第一人民医院放射科,浙江台州318020 [2]台州市第一人民医院神经内科,浙江台州318020

出　　处：《中国现代医生》2022年第20期59-62,66,共5页China Modern Doctor

基　　金：浙江省台州市科技计划项目(1902ky60);浙江省卫生健康面上项目(2021KY1209)。

摘　　要：目的探讨脑灌注相对参数在预测急性前循环大血管闭塞性脑卒中机械取栓后出血转化的价值。方法回顾性分析2021年1至11月台州市第一人民医院就诊的急性前循环大血管闭塞性脑卒中患者86例的临床及影像资料,通过纳入标准及排除标准,最终纳入患者51例,根据机械取栓治疗后复查是否发生出血转化分为出血转化组25例,非出血转化组26例,应用MIStar软件测量患侧低灌注区及梗死核心区的脑血容量(cerebral blood volume,CBV)、脑血流量(cerebral blood flow,CBF)、平均通过时间(mean transit time,MTT)、延迟时间(delay time,DT)参数,经中线镜像到健侧获取健侧相对应的灌注参数,并通过计算患侧与健侧的灌注参数比值得到相对脑血容量(relative cerebral blood volume,rCBV)、相对脑血流量(relative cerebral blood flow,rCBF)、相对平均通过时间(relative mean transit time,rMTT)、相对延迟时间(relative delay time,rDT)。分析两组患者的一般资料与灌注参数,采用受试者工作特征(receiver operating characteristic curve,ROC)曲线评估机械取栓治疗后出血转化的诊断效能。结果出血转化组和非出血转化组在年龄、性别、吸烟史、高血压、糖尿病、心房颤动、心肌梗死病史、高脂血症方面比较,差异无统计学意义(P>0.05)。出血转化组和非出血转化组在低灌注区的rCBV、rCBF和梗死核心区的rCBV、rCBF比较,差异有统计学意义(P<0.05)。低灌注区的rCBV、rCBF的曲线下面积(area under curve,AUC)分别为0.865和0.840,梗死核心区的rCBV、rCBF的AUC分别为0.737和0.709。结论脑灌注相对参数中的rCBV、rCBF可以用来预测急性前循环大血管闭塞性脑卒中患者经机械取栓后出血转化,对临床进行机械取栓治疗后出血转化的预测提供影像学指导。Objective To explore the value of cerebral perfusion relative parameters in hemorrhagic transformation after mechanical thrombectomy in acute anterior circulation large vessel occlusive stroke.Methods The clinical and imaging data of 86 patients with acute anterior circulation large vessel occlusive stroke admitted to Taizhou First People's Hospital from January to November 2021 were retrospectively analyzed.Through inclusion and exclusion criteria,51 patients were finally included.According to the results of brain imaging after mechanical thrombectomy,25 patients were divided into hemorrhagic transformation group and 26 patients were divided into non-hemorrhagic transformation group.The MIStar software was used to measure the cerebral blood volume(CBV),cerebral blood flow(CBF),mean transit time(MTT),and delay time(DT)in the hypoperfusion area and the infarction core area on the affected side.Perfusion parameters corresponding to the unaffected side were obtained by midline mirroring.The relative cerebral blood volume(rCBV),relative cerebral blood flow(rCBF),relative mean transit time(rMTT),and relative delay time(rDT)were obtained by calculating the ratio of perfusion parameters on the affected side to those on the unaffected side.The general data and perfusion parameters of the two groups were analyzed,and receiver operating characteristic curve(ROC)was used to evaluate the diagnostic efficacy of hemorrhagic transformation after mechanical thrombectomy.Results The differences in age,gender,smoking,hypertension,diabetes,atrial fibrillation,myocardial infarction and hyperlipidemia between the hemorrhagic transformation group and the non-hemorrhagic transformation group were not statistically significant(P>0.05).The differences of rCBV and rCBF in hypoperfusion area and in infarction core area between hemorrhagic transformation group and non-hemorrhagic transformation group were statistically significant(P<0.05).The area under curve(AUC)of rCBV and rCBF in the hypoperfusion area were 0.865 and 0.840,respectively.T

关 键 词：急性缺血性脑卒中 灌注成像 机械取栓 出血转化 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R651.1[医药卫生—临床医学]