多时相CTA评估急性缺血性脑卒中患者侧支循环的应用价值

The application of multiphase CT angiography in assessing collaterals of patients with acute ischemic stroke

目的探讨急性缺血性脑卒中(AIS)患者单时相血管成像(sCTA)和多时相血管(mCTA)侧支循环评分与CT灌注(CTP)目标不匹配之间的关系,比较三者对临床预后的评估价值。方法搜集单侧大脑中动脉M1段和(或)颈内动脉血管闭塞、发病时间在24 h内的AIS患者68例。比较sCTA和mCTA的侧支循环评分。基于受试者工作特征(ROC)曲线评价sCTA和mCTA侧支循环评分与CTP目标不匹配之间的关系及三者对临床预后的预估价值。结果 mCTA较sCTA能够显示更多的侧支血管。mCTA对CTP目标不匹配的评估效能(AUC=0.82;95%CI:0.727,0.877)及对临床预后的预测效能(AUC=0.851;95%CI:0.735,0.944)均优于sCTA(P<0.05)。当mCTA侧支循环>2分时,对CTP目标不匹配的评估效果最佳(敏感性93.6%,特异性66.7%)。mCTA与CTP目标不匹配对临床预后的评估效能相仿(P=0.29)。结论 mCTA联合CTP可用作AIS的初步诊断,更有助于指导临床诊疗。

Objective To compare collateral status on single-phase CT angiography(sCTA) and multiphase CT angiography(mCTA) and their ability to predict a target mismatch on CT perfusion(CTP) and clinical outcomes in patients with acute ischemic stroke(AIS).Methods Sixty-eight AIS patients with occlusions in the M1 segment of the middle cerebral artery and/or intracranial internal carotid artery within 24 h onset were included. The collaterals assessment of sCTA and mCTA were compared. The ability to predict target mismatch on CTP and clinical outcomes was compared between sCTA and mCTA by using receiver operating curve analysis.Results mCTA was better for visualizing collaterals when compared with sCTA. The ability of mCTA to predict target mismatch(AUC=0.82;95% CI:0.727,0.877) and clinical outcome(AUC=0.851;95% CI:0.735,0.944) was better than that of sCTA(P<0.05 overall). When it comes to collateral status>2, mSCTA predicted target mismatch on CTP was the best. The ability of mCTA to predict clinical outcome was comparable to CTP(P=0.29).Conclusion mCTA can be a new tool to combine with CTP for the imaging triage of patients with acute ischemic stroke.