CT血管造影-CT灌注成像参数可提高缺血性脑卒中侧支循环评估效能  

CT angiography-CT perfusion imaging parameters improve the efficacy in evaluating collateral circulation in ischemic stroke

作　　者：陈双 陈奕 姜亦伦 CHEN Shuang;CHEN Yi;JIANG Yilun(Imaging Center,Zhangjiagang First People's Hospital(Affiliated Zhangjiagang Hospital of Soochow University),Suzhou 215600,China;Imaging Center,Southeast University Affiliated Zhongda Hospital Wuxi Branch,Wuxi 214000,China)

机构地区：[1]张家港市第一人民医院(苏州大学附属张家港医院)影像中心,江苏苏州215600 [2]东南大学附属中大医院无锡分院影像中心,江苏无锡214000

出　　处：《分子影像学杂志》2025年第3期309-314,共6页Journal of Molecular Imaging

基　　金：江苏省卫生健康委科研项目(Z2019047)。

摘　　要：目的 分析CT血管造影(CTA)-CT灌注成像(CTP)对缺血性脑卒中侧支循环的评估价值。方法 回顾性收集2021年10月~2024年9月我院收治的150例急性缺血性脑卒中(AIS)患者的临床资料,根据侧支循环状态分为侧支循环不良组(n=56)和侧支循环良好组(n=94)。比较两组患者基线资料和CTA-CTP参数,分析导致AIS侧支循环不良的独立危险因素;绘制ROC曲线,以曲线下面积(AUC)评价各危险因素对导致AIS侧支循环不良的预测效能。结果 侧支循环不良组入院美国国立卫生研究院卒中量表(NIHSS)评分、高脂血症占比高于侧支循环良好组(P<0.05)。侧支循环不良组核心梗死体积、缺血半暗带体积及相对平均通过时间(rMTT)大于侧支循环良好组,而相对脑血流量(rCBF)、相对脑血容量(rCBV)小于侧支循环良好组(P<0.05)。Logistic回归分析结果显示,入院NIHSS评分、高脂血症占比、rCBF、rCBV及rMTT为导致AIS侧支循环不良的独立危险因素(P<0.05)。ROC曲线分析结果显示,rCBF、rCBV及rMTT预测AIS侧支循环不良的AUC分别为0.737、0.797、0.784,三者联合预测的AUC为0.886(95%CI:0.824~0.932),敏感度为94.64%,特异度为54.26%,联合预测因子AUC高于单独指标(P<0.001)。结论 入院NIHSS评分、高脂血症、rCBF、rCBV及rMTT与AIS患者侧支循环状态呈明显相关性,rCBF、rCBV及rMTT可作为侧支循环不良的预测指标,联合检测有助于提高预测准确性。Objective To analyze the value of CT angiography(CTA)-CT perfusion(CTP)imaging in evaluating collateral circulation in ischemic stroke.Methods The clinical data of 150 patients with acute ischemic stroke(AIS)admitted to the hospital from October 2021 to September 2024 were retrospectively collected.According to the status of collateral circulation,patients enrolled were divided into the poor collateral circulation group(n=56)and the good collateral circulation group(n=94).Baseline data and CTA-CTP parameters of the two groups were compared.The independent risk factors for poor collateral circulation in AIS were analyzed.The receiver operating characteristic curve was plotted and the area under the curve(AUC)was used to evaluate the predictive efficacy of each risk factor for poor collateral circulation in AIS.Results The National Institutes of Health Stroke Scale(NIHSS)score upon admission and the proportion of hyperlipidemia in the poor collateral circulation group were higher than those in the good collateral circulation group(P<0.05).The core infarct volume,ischemic penumbra volume and relative mean transit time(rMTT)in the poor collateral circulation group were larger and longer than those in the good collateral circulation group.The relative cerebral blood flow(rCBF)and relative cerebral blood volume(rCBV)were smaller than those in the good collateral circulation group(P<0.05).Logistic regression analysis results showed that NIHSS score upon admission,hyperlipidemia,rCBF,rCBV,and rMTT were independent risk factors for poor collateral circulation in AIS(P<0.05).The AUCs of rCBF,rCBV and rMTT to predict poor collateral circulation in AIS were 0.737,0.797,0.784.The AUC of joint prediction using the three factors was 0.886(95%CI:0.824-0.932).The sensitivity and specificity were 94.64 and 54.26%.The AUC of joint prediction was greater than that of separate prediction(P<0.001).Conclusion There's significant correlation between NIHSS score upon admission,hyperlipidemia,rCBF,rCBV,rMTT and collateral circulation in p

关 键 词：缺血性脑卒中 计算机断层扫描血管造影 计算机断层扫描灌注成像 侧支循环 

分 类 号：R74[医药卫生—神经病学与精神病学]