大血管闭塞急性缺血性卒中低灌注强度比与CTA侧支状态的相关性研究  

A Study on the Correlation between Low Perfusion Intensity Ratio and CTA Collateral Status in Acute Ischemic Stroke with Large Vessel Occlusion

作　　者：蔡青蓉[1] 刘坚[1] CAI Qing-rong;LIU Jian(Department of Radiology,Wuhan Hospital of Traditional Chinese Medicine,Wuhan 430014,Hubei Province,China)

机构地区：[1]武汉市中医医院放射科,湖北武汉430014

出　　处：《中国CT和MRI杂志》2024年第12期12-14,共3页Chinese Journal of CT and MRI

基　　金：武汉市医学科研项目(WX21D27)。

摘　　要：目的本研究旨在评估测试CTP衍生的低灌流强度比是否与CTA侧支循环状态相关,以及是否存在预测CTA侧支循环不良的阈值低灌流强度比。方法回顾分析连续收治的大血管闭塞急性缺血性卒中患者的影像和临床资料。通过受试者工作特征曲线分析,确定预测不良侧支循环的低灌流强度比的最佳阈值。结果纳入52例大血管闭塞急性缺血性卒中患者。多期CTA评分显示评价者间的一致性(k=0.813)好于单期CTA(TAN,k=0.587;MAAS,k=0.273)。低灌注率与CTA侧支循环积分相关(多期CTA:0.55;95%CI,0.67~0.40;P<0.001)。预测不良多期CTA侧支循环状态的最佳阈值是0.45的低灌注强度比(敏感度78%;特异度76%;曲线下面积0.86)。低灌流强度比高/侧支循环状态差的患者有更低的方面/更大的梗塞,更高的NIHSS评分,以及更大的低灌注量。结论大血管闭塞急性缺血性卒中患者的低灌流强度比与CTA侧支循环状态有关。对于临床和未来的卒中试验,低灌流强度比是CTA侧支循环评分方法的自动化和定量替代方法。Objective This study aims to evaluate whether the low perfusion intensity ratio derived from CTP testing is related to the collateral circulation status of CTA,and whether there is a threshold low perfusion intensity ratio for predicting poor collateral circulation in CTA.MethodsRetrospective analysis of imaging and clinical data of patients with acute ischemic stroke with large vessel occlusion who were admitted consecutively.Two specialist doctors used TAN,MAAS,and Calgary/Menon methods to perform single and multiple phase CTA scores.Use Rapid Processing Perfusion and Diffusion Software(RAPID)to process CTP.Low perfusion intensity ratio=ratio of brain volume to maximum time>10 seconds/ratio of maximum volume>6 seconds.Use Pearson correlation method to calculate the correlation between CTA collateral circulation score and low perfusion rate.Determine the optimal threshold for predicting the low perfusion intensity ratio of poor collateral circulation through the analysis of subject work characteristic curves.Results52 patients with acute ischemic stroke with large vessel occlusion were included.Multi stage CTA scores showed better consistency among evaluators(k=0.813)compared to single stage CTA(TAN,k=0.587;MAAS,k=0.273).Low perfusion rate is correlated with CTA collateral circulation score(multiphase CTA:0.55;95%CI,0.67-0.40;P<0.001).The optimal threshold for predicting poor multiphase CTA collateral circulation status is a low perfusion intensity ratio of 0.45(sensitivity 78%;specificity 76%;area under the curve 0.86).Patients with lower perfusion intensity compared to those with higher/poorer collateral circulation have lower/larger infarcts,higher NIHSS scores,and greater hypoperfusion volume.ConclusionThe low perfusion intensity ratio in patients with acute ischemic stroke with large vessel occlusion is related to the collateral circulation status of CTA.For clinical and future stroke trials,low perfusion intensity ratio is an automated and quantitative alternative to the CTA collateral circulation scoring

关 键 词：急性缺血性卒中 低灌注强度比 CTA侧支状态 大血管闭塞 

分 类 号：R543[医药卫生—心血管疾病]