侧支循环定量参数评估急性缺血性卒中患者临床预后的应用价值  

The application value of the quantitative parameters of collateral circulation in evaluating the clinical prognosis of patients with acute ischemic stroke

作　　者：范羡 王天乐[1] 朱丽[1] 李小龙[1] 阮席武[1] 汪晗 FAN Xian;WANG Tianle;ZHU Li;LI Xiaolong;RUAN Xiwu;WANG Han(Department of Radiology,the Second Affiliated Hospital of Nantong University,Nantong,Jiangsu Province 226000,China)

机构地区：[1]南通大学第二附属医院影像科,江苏南通226000

出　　处：《实用放射学杂志》2024年第10期1587-1591,共5页Journal of Practical Radiology

基　　金：南通市社会民生科技项目(MS2023068)。

摘　　要：目的探讨基于CT灌注成像(CTP)侧支循环定量参数评估急性缺血性卒中(AIS)患者临床预后的应用价值。方法选取126例大脑中动脉闭塞所致AIS患者,基于CTP源数据重建多时相CT血管成像(mCTA)侧支血管图像并评分,计算低灌注强度比(HIR)、侧支血管密集度(CVD),根据随访第90天改良Rankin量表(mRS)评分将患者分为预后良好组(72例)、预后不良组(54例),统计2组间在心血管危险因素、美国国立卫生研究院卒中量表(NIHSS)评分、Albert卒中项目早期CT(ASPECT)评分、Tmax>10 s体积、Tmax>6 s体积、核心梗死区体积、最终梗死体积之间的差异,二元logistic回归用于分析临床预后的独立预测因素。DeLong检验用于比较不同预测因素预测临床预后效能的差异。结果预后良好组ASPECT评分、mCTA评分、CVD高于预后不良组;HIR、Tmax>10 s体积、基线期NIHSS评分低于预后不良组,差异有统计学意义(P<0.05)。二元logistic回归分析结果显示ASPECT评分[比值比(OR)=0.780]、mCTA评分(OR=0.669)、CVD(OR=0.595)、HIR(OR=28.968)为临床预后的独立预测因素(P<0.05),DeLong检验显示mCTA评分、CVD、HIR三者预测AIS患者临床预后的曲线下面积(AUC)值差异无统计学意义(P>0.05)。结论侧支循环定量参数CVD、HIR对AIS患者90 d临床预后均具有较高的诊断效能。Objective To investigate the application value of the quantitative parameters of collateral circulation based on computed tomography perfusion(CTP)in evaluating the clinical prognosis of patients with acute ischemic stroke(AIS).Methods A total of 126 patients with AIS caused by middle cerebral artery occlusion were enrolled,collateral circulation were reconstructed and scored via multiphase computed tomography angiography(mCTA)based on CTP.The hypoperfusion intensity ratio(HIR)and collateral vessel density(CVD)were calculated.All patients were divided into good prognosis group(72 cases)and poor prognosis group(54 cases)based on 90 d modified Rankin scale(mRS)scores.Differences in cardiovascular risk factors,National Institutes of Health Stroke Scale(NIHSS)scores,Albert stroke program early CT(ASPECT)scores,Tmax>10 s volume,Tmax>6 s volume,core infarct area volume,and final infarct volume between the two groups were compared.Binary logistic regression was employed to identify independent predictors of the clinical prognosis,and the DeLong test was used to compare the efficacy of different predictors in predicting clinical prognosis.Results The good prognosis group had significantly higher ASPECT scores,mCTA scores,and CVD,but significantly lower HIR,Tmax>10 s volume,and baseline NIHSS scores compared to the poor prognosis group(P<0.05).Binary logistic regression analysis showed that ASPECT scores[odds ratio(OR)=0.780],mCTA scores(OR=0.669),CVD(OR=0.595),and HIR(OR=28.968)were independent predictors of clinical prognosis(P<0.05).DeLong test found no significant difference in area under the curve(AUC)values between mCTA scores,CVD and HIR in predicting the clinical prognosis of AIS patients(P>0.05).Conclusion Quantitative parameters such as CVD and HIR related to collateral circulation have a strong diagnostic efficacy in predicting the 90 d clinical prognosis in patients with AIS.

关 键 词：侧支循环 定量参数 CT灌注成像 急性缺血性卒中 

分 类 号：R814.42[医药卫生—影像医学与核医学] R742[医药卫生—放射医学]