CT灌注成像低灌注强度比值对急性脑梗死预后预测价值  

The Predictive Value of Low Perfusion Intensity Ratio in CT Perfusion Imaging for the Prognosis of Acute Cerebral Infarction

作　　者：周振寿[1] 叶成斌[1] 何岩燕 杜灏蓝[1] 潘洁娜 ZHOU Zhenshou;YE Chengbin;HE Yanyan;DU Haolan;PAN Jiena(Department of Radiology,Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine,Fuzhou 350004,China)

机构地区：[1]福建中医药大学附属人民医院放射影像科,福建福州350004

出　　处：《中华灾害救援医学》2024年第9期1034-1037,共4页Chinese Journal of Disaster Medicine

摘　　要：目的探析CT灌注成像低灌注强度比值(HIR)对急性脑梗死的预后预测价值。方法选取2023年5月至2024年4月福建中医药大学附属人民医院收治的80例急性脑梗死患者,按随访90 d行改良Rankin量表(mRS)评估结果将其划分为预后不良组(26例,mRS评分为3~5分)和预后良好组(54例,mRS评分为0~2分),对比组间各项资料差异,分析影响患者预后的因素,以及独立预测因素与预后的相关性。结果预后良好组入院NIHSS评分、侧支循环(CC)不丰富、HIR、相对低灌注区残余功能达峰时间(Tmax)均低于预后不良组(P<0.05),低灌注区相对脑血流量(rCBF)、相对血流容积(rCBV)均高于预后不良组(P<0.05);CC不丰富和HIR是发生预后不良的独立预测因素;CC不丰富、HIR与90 d mRS评分呈正相关;HIR及低灌注区rCBF、rCBV、rTmax对患者预后预测的曲线下面积(AUG)分别为0.982(0.925~0.997)、0.848(0.750~0.945)、0.851(0.756~0.946)、0.870(0.780~0.960),最佳截断值分别为0.41、0.56(ml·100 g^(-1)·min^(-1))、0.66(ml·100 g^(-1))、1.36 s,预测灵敏度、特异度均较高。结论CC不丰富和HIR是发生急性脑梗死预后不良的独立危险因素,运用CT灌注成像HIR对患者预后具有较高预测价值。Objective This study aims to evaluate the prognostic value of the hypoperfusion intensity ratio(HIR)derived from CT perfusion imaging in predicting outcomes in patients with acute cerebral infarction.Methods A total of 80 patients with acute cerebral infarction,treated in the Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine from May 2023 to April 2024,were included in this study.Based on the modified Rankin Scale(mRS)scores at the 90-day follow-up,patients were categorized into two groups:the poor prognosis group(26 patients with mRS scores of 3-5)and the good prognosis group(54 patients with mRS scores of 0-2).Differences between groups were compared,and factors influencing prognosis,as well as independent predictors,were analyzed.Results The good prognosis group had lower admission NIHSS scores,less extensive collateral circulation(CC),lower HIR,and shorter relative Tmax in the hypoperfused area compared to the poor prognosis group(P<0.05).The relative cerebral blood flow(rCBF)and relative cerebral blood volume(rCBV)in the hypoperfused area were higher in the good prognosis group(P<0.05).Poor CC and higher HIR were identified as independent predictors of poor prognosis.Both poor CC and higher HIR were positively correlated with 90-day mRS scores.The areas under the curve(AUC)for predicting patient outcomes using HIR,rCBF,rCBV,and relative Tmax in the hypoperfused area were 0.982(0.925-0.997),0.848(0.750-0.945),0.851(0.756-0.946),and 0.870(0.780-0.960),respectively.The optimal cutoff values were 0.41,0.56(ml•100 g^(-1)•min^(-1)),0.66(ml•100 g^(-1)),and 1.36 s,with high sensitivity and specificity for prognosis prediction.Conclusion Poor collateral circulation and higher HIR are independent risk factors for poor prognosis in acute cerebral infarction.CT perfusion imaging using HIR provides significant predictive value for patient outcomes.

关 键 词：体层摄影术 X线 脑梗死 预后 

分 类 号：R445[医药卫生—影像医学与核医学]