多期CT血管成像对急性缺血性卒中血管内治疗短期预后的价值  

Value of Multiphase CT Angiography for Short⁃Term Prognosis of Endovascular Therapy in Acute Ischemic Stroke

作　　者：张远[1] 王浩[1] 朱杰[1] 宋彬[1] ZHANG Yuan;WANG Hao;ZHU Jie;SONG Bin(Department of Radiology,Minhang Hospital,Fudan University)

机构地区：[1]市复旦大学附属闵行医院放射科

出　　处：《中国医学计算机成像杂志》2024年第1期110-115,共6页Chinese Computed Medical Imaging

摘　　要：目的:探讨多期CT血管成像对急性缺血性卒中(AIS)血管内治疗短期预后的价值。方法:回顾性分析183例接受血管内治疗的AIS患者,按随访90 d改良Rankin量表(mRS)评分分为预后良好(mRS评分≤2)组和预后不良(mRS评分>2)组。通过改良Tan评分评估多期CT血管成像显示的侧支循环情况,侧支循环不良为闭塞大脑中动脉区域的侧支循环小于对侧1/2,侧支循环良好为闭塞大脑中动脉区域的侧支循环大于对侧1/2。采用多变量logistic回归,曲线下面积(AUC)评价模型性能,DeLong检验比较AUC间的差异。结果:Logistic回归显示,较低入院NIHSS评分和动脉晚期侧支循环良好是AIS患者短期预后良好的独立预测因素,AUC分别为0.72(0.65~0.79)和0.75(0.68~0.81)。两者联合时AUC可达0.79,显著高于单一预测因素(DeLong检验,均P<0.05)。结论:动脉晚期侧支循环良好和较低入院NIHSS评分是血管内治疗短期预后良好的独立预测因素。联合预测模型具有较高的诊断效能,可为临床治疗方案选择提供参考。Purpose:To investigate the value of multiphase CT angiography for the short-term prognosis of acute ischemic stroke(AIS)after endovascular therapy(EVT).Methods:A total of 183 AIS patients who underwent EVT were retrospectively analyzed.According to the modified Rankin scale(mRS)score after 90 days of follow-up,patients were divided into favorable outcomes(mRS score≤2)group and unfavorable outcomes(mRS score>2)group.The collateral circulation status provided by multiphase CT angiography was assessed using the modified Tan score.Poor collateral circulation was defined when the collateral circulation accounted for less than half of the contralateral middle cerebral artery occlusion area,and good collateral circulation was defined when the collateral circulation accounted for more than half of the contralateral middle cerebral artery occlusion area.Multivariate logistic regression and area under the curve(AUC)were used to evaluate the performance of the model,and the DeLong test was used to compare the differences between AUCs.Results:Logistic regression showed that lower NIHSS score at admission and good late arterial collateral circulation were independent predictors of good short-term prognosis in AIS patients,with an AUC of 0.72(0.65-0.79)and 0.75(0.68-0.81).The AUC of the combination of the two predictors was 0.79,which was significantly higher than that of the individual predictor(DeLong test,all P<0.05).Conclusions:Good late arterial collateral circulation and lower NIHSS score at admission are independent predictors of good short-term prognosis after EVT.The combined prediction model has high diagnostic efficiency,which can serve as a for clinical treatment options.

关 键 词：急性缺血性卒中 血管内治疗 CT血管成像 预后 

分 类 号：R445.3[医药卫生—影像医学与核医学]