一站式多模态CT对急性缺血性脑卒中机械性取栓术后出血性转化的预测分析  

Prediction and Analysis of Hemorrhagic Transformation after Mechanical Thrombectomy in Acute Ischemic Stroke Using One-stop Multimodal CT

作　　者：解福友[1] 高建磊[1] 张方圆 刘艺超[1] 马龙[2] 韩若东 XIE Fu-you;GAO Jian-lei;ZHANG Fang-yuan;LIU Yi-chao;MA Long;HAN ruo-dong(Imaging Center,Bozhou People's Hospital,Bozhou 236800,Anhui Province,China;Department of Neurology,Bozhou People's Hospital,Bozhou 236800,Anhui Province,China;Department of Intensive Care Medicine,Bozhou People's Hospital,Bozhou 236800,Anhui Province,China)

机构地区：[1]亳州市人民医院影像中心,安徽亳州236800 [2]亳州市人民医院神经内科,安徽亳州236800 [3]亳州市人民医院重症医学科,安徽亳州236800

出　　处：《中国CT和MRI杂志》2025年第2期12-15,28,共5页Chinese Journal of CT and MRI

基　　金：安徽省高校科研重点项目(2022AH050688);2024亳州市卫生健康科研项目(bzwj2024b024)。

摘　　要：目的 探讨一站式多模态CT对急性缺血性脑卒中(AIS)患者机械性取栓术后出血性转化的预测价值。方法 回顾性收集2022年2月至2024年7月于亳州市人民医院接受机械性取栓术治疗的120例AIS患者资料,根据患者术后24h内出血转化发生情况分为发生组(n=25)与未发生组(n=95)。比较两组术前一站式多模态CT检查参数[动脉高密度征(HMCAS)、脑血容量(CBV)、脑血流量(CBF)、达峰时间(TTP)、血流峰值时间(Tmax)、表面渗透性(PS)、侧支循环评分]及其他临床资料,建立回归模型验证主要参数指标与AIS患者机械性取栓术后出血转化的关系;绘制受试者工作特征(ROC)曲线及决策曲线评价一站式多模态CT检查参数对AIS患者机械性取栓术后出血转化的预测价值。结果 发生组一站式多模态CT检查参数CBV、CBF、侧支循环评分低于未发生组,HMCAS占比、PS高于未发生组(P<0.05);发生组血管闭塞部位为前循环占比及入院时美国国立卫生院神经功能缺损评分(NIHSS)评分高于未发生组(P<0.05)。建立Logistic回归模型显示,AIS患者机械性取栓术后出血转化可能与一站式多模态CT检查参数CBV、CBF、PS、侧支循环评分及入院时NIHSS评分有关(P<0.05)。ROC曲线显示,CBV、CBF、PS、侧支循环评分单独及联合检测对AIS患者机械性取栓术后出血转化均有一定预测价值(曲线下面积均>0.7),且联合预测价值更高。决策曲线显示,阈值在0.00-0.82范围内,一站式多模态CT检查参数联合预测AIS患者机械性取栓术后出血转化的净受益率始终大于0,净受益率最大值为0.208。结论 一站式多模态CT对AIS患者机械性取栓术后出血转化有一定预测价值,可为临床决策提供参考。Objective To explore the predictive value of one-stop multimodal CT for hemorrhagic transformation after mechanical thrombectomy in patients with acute ischemic stroke(AIS). Methods A retrospective collection of data was conducted on 120 AIS patients who underwent mechanical thrombectomy in hospitals from February 2022 to July 2024. According to the occurrence of bleeding transformation within 24 hours after surgery, the patients were divided into an incidence group(n=25) and a non incidence group(n=95). Two sets of preoperative one-stop multimodal CT examination parameters [arterial high-density sign(HMCAS), cerebral blood volume(CBV), cerebral blood flow(CBF), time to peak(TTP), time to peak blood flow(Tmax), surface permeability(PS), collateral circulation score] and other clinical data were compared. A regression model was established to verify the relationship between the main parameter indicators and the transformation of bleeding after mechanical thrombectomy in AIS patients. The receiver operating characteristic(ROC) curve and decision curve were drawn to evaluate the predictive value of one-stop multimodal CT examination parameters for hemorrhagic transformation after mechanical thrombectomy in AIS patients. Results The parameters CBV,CBF,and collateral circulation score of the one-stop multimodal CT examination in the incidence group were lower than those in the non incidence group, while the proportion of HMCAS and PS were higher than those in the non incidence group(P<0.05).The proportion of vascular occlusion in the anterior circulation and the National Institutes of Health Neurological Deficit Score(NIHSS) score at admission in the incidence group were higher than those in the non incidence group(P<0.05).The establishment of a Logistic regression model showed that the transformation of bleeding in AIS patients after mechanical thrombectomy may be related to the parameters CBV,CBF,PS, collateral circulation score, and NIHSS score at admission on one-stop multimodal CT examination(P<0.05). The ROC cur

关 键 词：急性缺血性脑卒中 机械性取栓术 出血转化 一站式多模态CT 预测价值 

分 类 号：R743.3[医药卫生—神经病学与精神病学]