DWI-ASPECTS预测急性期大脑中动脉供血区梗死静脉溶栓患者侧支循环代偿的价值

DWI-ASPECTS predicts collateral circulation compensation in patients with acute middle cerebral artery infarction after intravenous thrombolysis

目的评价弥散加权成像Alberta早期CT评分(DWI-ASPECTS)对大脑中动脉狭窄或闭塞的脑卒中静脉溶栓患者侧支循环建立的预测价值。方法收集影像学证实为大脑中动脉重度狭窄或闭塞的缺血性脑卒中患者178例,给予rt-PA静脉溶栓。采集患者临床基线数据。采用NIHSS评分、m RS评分和DWI-ASPECT评分。通过头颈CTA评估软脑膜侧支循环。结果侧支循环代偿较好组三酰甘油、DWI-ASPECT评分明显高于侧支循环代偿较差组(P<0.05)。而侧支循环代偿较好组高血压患病率、溶栓前后NIHSS评分、m RS评分明显低于侧支循环代偿较差组(P<0.05)。与侧支循环代偿较好组相比,侧支循环代偿较差组梗死常累及DWI-ASPECTS中的M1~M4、M6和岛叶区域,且差异有统计学意义(P<0.05)。DWI-ASPECTS预测软脑膜侧支循环建立的ROC曲线下面积为0.932,截点为7.50,敏感度为81%,特异度为94.1%。结论软脑膜侧支循环能充分保障脑皮质及皮质下区域(M1~M4、M6和岛叶)血供,DWI-AS-PECTS可有效预测急性大脑中动脉供血区脑梗死患者侧支循环代偿。

Objective To evaluate the value of Alberta Stroke Program Early CT Score on diffusion weight-ed imaging（DWI-ASPECTS）in predicting the leptomeningeal collateral circulation（LMA）compensation of isch-emic stroke with middle cerebral artery stenosis or occlusion after intravenous thrombolysis. Methods A total of178 patients with ischemic stroke confirmed as severe middle cerebral artery stenosis or occlusion by imaging wereenrolled in the study.All the patients were treated by rt-PA intravenous thrombolysis. The baseline clinical date,DWI-ASPECTS,mRS and NIHSS were collected. LMA was assessed by cranio-cervical CTA. Results Comparedwith the poor collateral circulation group,the triglyceride level and DWI-ASPECTS were significantly increased ingood collateral circulation group（P〈0.05）. The proportion of hypertension,NIHSS score,mRS score in good col-lateral circulation group were significantly lower than those in the poor collateral circulation group（P〈0.05）.Compared with the poor collateral circulation group,insula,the ASPECTS areas M1 to M4,M6 and insula showedsignificantly fewer infarctions in good collateral circulation group（P〈0.05）. ROC analysis showed the area underROC curve（AUC）of DWI-ASPECTS to predict LMA compensation were 0.932,the cutoff point of DWI-ASPECTSwas 7.5.the sensitivity and specificity were 81.% and 94.1%. Conclusions The tissue protective role of good lepto-meningeal collateralization seems to be more pronounced in cortical and subcortical areas M1 to M4,M6 and the in-sula. DWI-ASPECTS can effectively predict the collateral circulation compensation in patients with acute middle ce-rebral artery infarction.