脑CT灌注成像联合CTA技术预测急性缺血性脑卒中患者预后不良的临床价值  

Clinical value of cerebral CT perfusion imaging combined with CTA in predicting poor prognosis of patients with acute ischemic stroke

作　　者：刘明 黄玉伟 李定柯 LIU Ming;HUANG Yu-wei;LI Ding-ke(Department of Medical Imaging,Nanyang Nanshi Hospital,Nanyang 473000,Henan,CHINA)

机构地区：[1]南阳南石医院医学影像科,河南南阳473000

出　　处：《海南医学》2024年第23期3430-3434,共5页Hainan Medical Journal

基　　金：2023年度河南省医学科技攻关计划联合共建项目(编号:LHGJ20232959)。

摘　　要：目的探讨脑CT灌注成像(CTP)联合CT血管造影(CTA)技术预测急性缺血性脑卒中(AIS)患者预后不良的临床价值。方法前瞻性选取2022年5月至2023年10月南阳南石医院收治的104例AIS患者作为研究对象,所有患者均随访6个月,失访4例,共100例完成随访,根据预后情况分为预后不良组20例和预后良好组80例。比较两组患者的基线资料、CTP参数[相对脑血流量(rCBF)、相对平均通过时间(rMTT)、相对脑血容量(rCBV)、相对达峰时间(rTTP)]和CTA评分,采用Pearson相关性分析CTP参数与CTA评分的相关性,采用偏相关性分析CTP参数、CTA评分与预后不良的关系,采用受试者工作特征(ROC)曲线及曲线下面积(AUC)评估CTA评分和CTP参数对预后不良的预测价值。结果预后不良组和预后良好组患者的年龄[(63.57±4.50)岁vs(57.49±3.72)岁]、NIHSS评分[(13.86±1.74)分vs(12.10±1.39)分]、脑梗死面积[(60.53±8.13)mm2 vs(45.91±6.52)mm2]、糖尿病比例(25.00%vs 6.25%)比较,预后不良组明显高于预后良好组,差异均有统计学意义(P<0.05);预后不良组和预后良好组患者的rCBF[(0.56±0.17)mL/(kg·min)vs(0.78±0.25)mL/(kg·min)]、rCBV[(0.59±0.12)mL/100 g vs(0.75±0.15)mL/100 g]、CTA评分[(1.82±0.55)分vs(3.08±0.97)分]比较,预后不良组明显低于预后良好,rMTT[(2.17±0.33)s vs(1.92±0.21)s]、rTTP[(1.44±0.30)s vs(1.19±0.24)s]比较,预后不良组明显长于预后良好,差异均有统计学意义(P<0.05);Pearson相关性分析结果显示,rCBF、rCBV与CTA评分呈正相关(r=0.713、0.835,P<0.05),rMTT、rTTP与CTA评分呈负相关(r=-0.708、-0.756,P<0.05);偏相关分析结果显示,rCBF、rCBV、rMTT、rTTP、CTA评分与AIS患者预后不良显著相关(P<0.05);ROC曲线结果分析显示,rCBF、rCBV、rMTT、rTTP、CTA评分联合预测AIS患者预后不良的AUC最大(0.943),敏感度为90.00%,特异度为90.00%,明显大于各指标单独预测(P<0.05)。结论脑CTP定量参数、CTA评分与AIS患者预后不良有关,Objective To investigate the clinical value of cerebral CT perfusion imaging(CTP)combined with CT angiography(CTA)in predicting poor prognosis in patients with acute ischemic stroke(AIS).Methods A total of 104 AIS patients admitted to Nanyang Nanshi Hospital from May 2022 to October 2023 were prospectively selected and followed up for 6 months,of which 4 were lost to follow-up.A total of 100 patients completed the follow-up and were di-vided into the poor prognosis group(n=20)and the good prognosis group(n=80)according to the prognosis.Baseline da-ta,CTP parameters(relative cerebral blood flow[rCBF],relative mean time to transit[rMTT],relative cerebral blood volume[rCBV],relative time to peak[rTTP])and CTA scores of the two groups were compared.Pearson correlation analysis was used to analyze the correlation between CTP parameters and CTA scores.The correlation between CTP pa-rameters,CTA score and poor prognosis was analyzed by partial correlation analysis.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the predictive value of CTA score and CTP parame-ters for poor prognosis.Results Patients in the poor prognosis group had significantly older age,higher NIHSS score,larger cerebral infarction area,and higher rate of diabetes than patients in the good prognosis group(all P<0.05):age,(63.57±4.50)years vs(57.49±3.72)years;NIHSS score,(13.86±1.74)points vs(12.10±1.39)points;cerebral infarction area,(60.53±8.13)mm2 vs(45.91±6.52)mm2;and rate of diabetes,25.00%vs 6.25%.Patients in the poor prognosis group had lower rCBF,rCBV,and CTA scores but longer rMTT and rTTP than patients in the good prognosis group(all P<0.05):rCBF,(0.56±0.17)mL/(kg·min)vs(0.78±0.25)mL/(kg·min);rCBV,(0.59±0.12)mL/100 g vs(0.75±0.15)mL/100 g;CTA,(1.82±0.55)points vs(3.08±0.97)points;rMTT,(2.17±0.33)s vs(1.92±0.21)s;rTTP,(1.44±0.30)s vs(1.19±0.24)s.Pearson correlation analysis showed that rCBF and rCBV were positively correlated with CTA scores(r=0.713,0.835,P<0.05),while rMTT and rT

关 键 词：急性脑卒中 脑CT灌注成像 CT血管造影 预后不良 预测 

分 类 号：R743.3[医药卫生—神经病学与精神病学]