超急性期脑梗死的多层螺旋CT灌注成像与脑卒中评分及预后相关性的研究

Study on the relationship among multi-slice CT perfusion and National Institutes of Health Stroke Scale Score and clinical outcome in patients at hyperacute stroke

目的探讨超急性期脑梗死的多层螺旋CT(MSCT)灌注成像与临床神经功能缺损评分及预后的相关性。方法对25例临床拟诊大脑半球缺血的患者,在发病6h内进行MSCT灌注成像,同时由临床医师进行脑卒中评分(NIHSS);于30～40d后对其中23例患者进行随访。分析影像检查结果与临床的相关性。结果(1)NIHSS初的线性回归方程为:Y=-3.12+6.70X1+0.001X2+4.21X3,其中X1为并发症(无并发症X1=1,有并发症X1=2)(t=4.77,P=0.000),X2为脑血流量图所示缺血面积(面积CBF)(t=2.69,P=0.015),X3为缺血部位(大脑前动脉或大脑后动脉X3=1,大脑中动脉X3=2)(t=2.44,P=0.026);(2)NIHSS终的线性回归方程为:Y=2.62+6.26X1-0.23X2,其中X1为并发症(无并发症X1=1,有并发症X1=2)(t=4.15,P=0.001),X2为缺血程度(t=-2.64,P=0.016);(3)缺血脑组织可恢复比率(potentialrecuperationratio,PRR)=面积半暗带/(面积半暗带+面积梗死),与神经功能恢复比率(NIHSS差/NIHSS初)有相关关系(r=0.502,P=0.020)。结论NIHSS评分与面积CBF无相关关系,而与多种因素有关,非单一因素所决定;PRR可以预测半暗带并提示临床预后,为临床治疗提供有价值的信息。

Objective To investigate the correlation of multi-slice CT (MSCT) perfusion with the clinical condition at hyperacute stroke and clinical outcome. Methods MSCT perfusion was performed in 25 patients with acute ischemic stroke within 6 hours of symptom onset. Follow-up CT or MRI was performed in 23 patients 30-40 days after symptom onset. A potential recuperation ratio, defined as PRR=penumbra size / (penumbra size + infarct size) on the admission perfusion CT, was compared with the evaluation in each patient′s clinical condition, and the National Institutes of Health Stroke Scale (NIHSS) was scored. The correlation of NIHSS with PRR and perfusion results was studied. Results (1) Linear regression of initial NIHSS was: Y=-3.12+6.70 X_1+0.001 X_2+4.21 X_3, X_1 was complication (No X_1=1, Yes X_1=2) (t=4.77,P=0.000), X_2 was the size of CBF (t=2.69,P=0.015), X_3 was the location (ACA or PCA X_3=1, MCA X_3=2)(t=2.44,P=0.026). (2) Linear regression of NIHSS in clinical outcome was: Y=2.62+6.26X_1-0.23X_2, X_1 was complication (No X_1=1, Yes X_1= 2) (t=4.15,P=0.001), X_2 was severity of ischemia (t=-2.64,P=0.016). (3) The PRR correlated with the improvement in the NIHSS evaluated on admission and after a month(r=0.502,P=0.020). Conclusion (1) There is no correlation between NIHSS and CT perfusion in this study, which indicates that the NIHSS score may relate to complex factors. (2) MSCT perfusion study may provide information about the extent of the penumbra. MSCT perfusion could therefore be a valuable tool in predicting clinical prognosis.