急性缺血性卒中机械取栓患者CT灌注成像的应用研究  

CT cerebral perfusion imaging for patients with mechanical thrombectomy in acute ischemic stroke

作　　者：戴鑫雨 李秋璇 於帆 李源 张苗[1] 马青峰[2] 焦力群[3] 卢洁[1] Dai Xinyu;Li Qiuxuan;Yu Fan;Li yuan;Zhang Miao;Ma Qingfeng;Jiao Liqun;Lu Jie(Department of Radiology and Nuclear Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;不详)

机构地区：[1]首都医科大学宣武医院放射与核医学科,北京100053 [2]首都医科大学宣武医院神经内科,北京100053 [3]首都医科大学宣武医院神经外科,北京100053

出　　处：《中国脑血管病杂志》2023年第8期513-523,共11页Chinese Journal of Cerebrovascular Diseases

基　　金：北京市自然科学基金(Z190014)。

摘　　要：目的探讨脑CT灌注(CTP)成像评价急性缺血性卒中(AIS)机械取栓的应用价值。方法回顾性连续纳入2019年12月至2022年4月首都医科大学宣武医院急性卒中绿色通道收治的行机械取栓治疗的AIS患者。收集患者入院后一般资料,包括性别、年龄、入院距最后正常时间、基线美国国立卫生研究院卒中量表(NIHSS)评分、入院Alberta卒中项目早期CT评分(ASPECTS)等。收集手术相关资料,包括血管闭塞部位(颈内动脉和大脑中动脉M1段、M2段)、是否术前静脉溶栓、术后血管再通程度[改良脑梗死溶栓(mTICI)分级]以及术后患者临床预后情况。所有患者机械取栓治疗前及术后3 d内行头部CT平扫及CTP。通过CTP图像识别灌注异常区,灌注异常表现为缺血区域脑血流量(CBF)减低、伴或不伴脑血容量(CBV)减低,且对比剂平均通过时间(MTT)、达峰时间(TTP)、残余功能达峰时间(Tmax)延迟。比较手术前后灌注异常区范围及各灌注参数相对值[病变侧数值除以健侧数值,包括相对脑血流量(rCBF)、相对脑血容量(rCBV)、对比剂相对平均通过时间(rMTT)、相对达峰时间(rTTP)、残余功能相对达峰时间(rTmax)]。根据机械取栓术后CTP图像灌注异常范围的改变情况将患者分为灌注异常范围无改善组(灌注异常范围增大或无明显变化)、灌注异常范围减小组及灌注异常范围消失组。采用NIHSS评分评估机械取栓术后7 d或出院神经功能改变情况,将ΔNIHSS评分(基线NIHSS评分与术后7 d或出院NIHSS评分差值)>4分或术后7 d或出院NIHSS评分0~1分定义为NIHSS评分改善。临床结局为通过门诊或电话随访评估的术后90 d改良Rankin量表(mRS)评分,0~2分为预后良好,3~6分为预后不良。结果共纳入AIS患者67例,其中男42例,女25例;年龄34~97岁,平均(65±12)岁;入院距最后正常时间0~19 h,中位时间6(2,10)h;基线NIHSS评分4~26分,中位评分13(10,19)分;26例行静脉溶栓+机械取Objective To explore the value of CT perfusion(CTP)in evaluating mechanical thrombectomy for patients with acute ischemic stroke.Methods Consecutive patients who were treated in the AIS Greenway Department of Xuanwu Hospital,Capital Medical University and underwent thrombectomy for AIS from December 2019 to April 2022 were analyzed retrospectively.General data were collected,including gender,age,time from last normal to admission,baseline National Institutes of Health stroke scale(NIHSS)score and admission Alberta stroke program early CT score(ASPECTS),etc.Data relative to thrombectomy were collected,including occlusion site(internal carotid artery,middle cerebral artery M1 and M2),whether intravenous thrombolysis before thrombectomy,postoperative vascular recanalization condition(evaluated by modified thrombolysis in cerebral infarction score[mTICI])and postoperative clinical outcome.Noncontrast CT and CTP were performed before thrombectomy and within 3 days after thrombectomy.Abnormal perfusion lesion was recognized based on the CTP imaging,presenting as cerebral blood flow(CBF)decreased,with or without cerebral blood volume(CBV)decreased,and mean transit time(MTT),time to peak(TTP)and time to maximum of the residual function(Tmax)delayed.The difference of abnormal perfusion lesion and the relative value of each perfusion parameter(calculated by dividing the value of affected side by the unaffected side,including relative cerebral blood flow[rCBF],relative cerebral blood volume[rCBV],relative mean transit time[rMTT],relative time to peak[rTTP]and relative time to maximum of the residual function[rTmax])before and after thrombectomy were compared.According to the changes of abnormal perfusion lesion on CTP imaging after thrombectomy,patients were divided into the group with abnormal perfusion lesion had no improvement(abnormal perfusion lesion increased or changed little),the group with abnormal perfusion lesion decreased and the group with abnormal perfusion lesion disappeared.The NIHSS score was used to evalua

关 键 词：缺血性卒中 体层摄影术 X线计算机 灌注成像 机械取栓术 脑血流灌注 

分 类 号：R743.3[医药卫生—神经病学与精神病学]