全脑CT灌注及磁共振弥散加权成像评价短暂性脑缺血发作继发脑梗死的价值  

Evaluative value of whole brain CT perfusion and magnetic resonance diffusion weighted imaging for secondary cerebral infarction following transient ischemic attack

作　　者：常小娜 何文进 蔡炜琼 钟立清[1] 丁庆社 代琳玉 郑美娴 邱广美 曹玉竹 卢睿 杨世泉[1] CHANG Xiaona;HE Wenjin;CAI Weiqiong;ZHONG Liqing;DING Qingshe;Dai Linyu;ZHENG Meixian;QIU Guangmei;CAO Yuzhu;LU Rui;YANG Shiquan(nd Hospital of China People’s Liberation Army Joint Logistic Support Force,Bengbu 233000,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇二医院,安徽蚌埠233000

出　　处：《中国实用神经疾病杂志》2024年第1期37-42,共6页Chinese Journal of Practical Nervous Diseases

基　　金：联勤保障部队战勤部面上重点项目(编号:CLB20J026)。

摘　　要：目的探究全脑CT灌注及磁共振弥散加权成像(DWI)评价短暂性脑缺血发作(TIA)继发脑梗死的价值。方法选取2022-06—2023-04中国人民解放军联勤保障部队第九〇二医院治疗的70例TIA患者,对其临床资料进行回顾性分析,根据患者发病7 d内临床诊断继发性脑梗死状况分为脑梗死组(n=22)与非脑梗死组(n=48),对比2组全脑CT灌注参数,经ROC曲线分析全脑CT灌注参数联合诊断TIA继发脑梗死的最佳阈值,对比全脑CT灌注参数、DWI及两项联合诊断TIA继发脑梗死的灵敏度、特异性,并通过Kappa值分析其一致性。结果脑梗死组CBF、CBV低于非脑梗死组,TTP、MTT高于非脑梗死组(P<0.05)。采用ROC分析获取CBF、CBV、TTP、MTT诊断TIA继发脑梗死的AUC分别为0.670、0.854、0.681、0.754,联合诊断TIA继发脑梗死的AUC为0.925。以临床诊断为金标准,全脑CT灌注诊断TIA继发脑梗死的敏感度77.27%,特异性95.83%,Kappa值0.759;磁共振弥散加权成像诊断TIA继发脑梗死的敏感度81.82%,特异性97.92%,Kappa值0.828;两项联合诊断TIA继发脑梗死的敏感度95.45%,特异性95.83%,Kappa值0.902,一致性较好。结论全脑CT灌注及DWI诊断TIA继发脑梗死均具有一定价值,且两项联合诊断的准确性更好。Objective To probe the evaluative value of whole brain CT perfusion and magnetic resonance diffusion weighted imaging(DWI)for transient ischemic attack(TIA)secondary cerebral infarction.Methods A retrospective analysis was conducted on the clinical data of 70 patients with TIA admitted to the 902nd Hospital of China People’s Liberation Army Joint Logistic Support Force from June 2022 to April 2023.Based on the clinical diagnosis of secondary cerebral infarction within 7 days after the onset of the disease,the patients were divided into cerebral infarction group(n=22)and non-cerebral infarction group(n=48).The differences in CT perfusion parameters between the two groups were compared,and the optimal threshold for diagnosing TIA secondary cerebral infarction was determined through ROC curve analysis and combined data analysis,the sensitivity and specificity of whole brain CT perfusion parameters,DWI,and two combined diagnostic methods for TIA secondary cerebral infarction were compared,and their consistency through Kappa values were analyzed.Results The CBF and CBV in the cerebral infarction group were lower than those in the non-cerebral infarction group,while TTP and MTT were higher than those in the non-cerebral infarction group(P<0.05).The AUC of TIA secondary cerebral infarction diagnosed with CBF,CBV,TTP,and MTT using ROC analysis was 0.670,0.854,0.681,and 0.754,respectively.The AUC of TIA secondary cerebral infarction diagnosed with combined data was 0.925.Using clinical diagnosis as the gold standard,the sensitivity of whole brain CT perfusion in diagnosing TIA secondary cerebral infarction is 77.27%,the specificity is 95.83%,and the Kappa value is 0.759.The sensitivity,specificity,and Kappa value of magnetic resonance diffusion weighted imaging in diagnosing TIA secondary cerebral infarction were 81.82%,97.92%,and 0.828,respectively.The sensitivity and specificity of the two combined diagnoses for TIA secondary cerebral infarction were 95.45%,95.83%,and the Kappa value was 0.902,indicating a good consis

关 键 词：短暂性脑缺血发作 脑梗死 全脑CT灌注 磁共振弥散加权成像 预测价值 

分 类 号：R743.31[医药卫生—神经病学与精神病学]