急性脑梗死再通术后即刻平扫CT高密度影对短期预后的预测价值

Predictive value of non-contrast CT hyperdensity on short-time prognosis after successful recanalization of acute anterior circulation occlusion cerebral infarction

目的探讨取栓患者术后即刻CT高密度影与最终梗死体积及出院时改良Rankin量表(modified Rankin scale,mRS)评分相关指标之间的关系。方法搜集取栓成功再通的急性前循环大动脉闭塞性脑梗死患者28例。采用ASPECTS评分法,半定量评估术后即刻平扫CT高密度区(post-thrombectomy ASPECTS,PTASPECTS)以及最终梗死体积(infarct volume ASPECTS,IV-ASPECTS)。将出院时mRS评分分为预后良好组(0~2分)和预后不良组(3~6分)进行比较。采用线性相关分析及多元线性回归分析寻找IV-ASPECTS评分及出院时mRS评分的影响因素。结果预后良好组13例(46.4%),预后不良组15例(53.6%)。与预后良好组比较,预后不良组患者术前NIHSS评分、术前mRS评分、出院时NIHSS评分更高,术前ASPECTS、PT-ASPECTS、IVASPECTS评分更低,出血转化率更高,住院时间更长。相关分析显示PT-ASPETS评分与IV-ASPECTS评分高度相关;PT-ASPECTS评分与出院时mRS评分之间也明显相关。回归分析显示PT-ASPECTS评分是最终梗死体积以及出院时预后不良的主要影响因素。结论基于取栓术后即刻平扫CT显示的高密度进行PT-ASPETS评分能一定程度上预测患者的最终梗死体积、以及出院时的预后不良。本研究有望为临床提供一种简单、可行的术后早期预测指标,以评估取栓患者短期预后。

Objective To investigate the relationship between the CT hyperdensity immediately after thrombectomy with the final infarct volume and the modified Rankin Scale(mRS)score at discharge in successful recanalization patients with acute anterior circulation occlusion cerebral infarction.Methods From July 2018 to September 2019,acute cerebral infarction patients in anterior circulation for large artery occlusion and received endovascular mechanical thrombectomy in the Department of Neurology,the First Affiliated Hospital of Anhui Medical University were collected.All collected patients met the standard of thrombectomy recommended by the guidelines.On the basis of non-contrast CT(NCCT),post-thrombectomy CT hyperdensity(PT-ASPECTS)and the final infarct volume(IVASPECTS)were evaluated according to the ASPECTS scoring criteria.Based on mRS score at discharge,the patients were divided into good prognosis group(0~2 points)and poor prognosis group(3~6 points).Linear correlation analysis and multiple linear regression analysis were used to examine the influencing factors of IV-ASPECTS score and m RS score at discharge.Results A total of 28 patients were enrolled,including 18 males(64.3%)and 10 females(35.7%),with an average age of 65.6±13.5 years(23~85 years).Onset to Puncture Time was 170~510 min,and thrombectomy was performed after 6 hours in 9 cases(32.1%).There were 13 cases(46.4%)in good prognosis group and 15 cases(53.6%)in poor prognosis group.Compared with the good prognosis group,the poor prognosis group had higher NIHSS score,higher pre-thrombectomy mRS score,higher NIHSS score at discharge,lower pre-thrombectomy ASPECTS,PT-ASPECTS and IV-ASPECTS scores,higher hemorrhagic transformation rate and longer hospital stay.Correlation analysis showed that PT-ASPECTS score was highly correlated with IV-ASPECTS score(correlation coefficient was 0.864);PTASPECTS score was also significantly correlated with mRS score at discharge.Regression analysis showed that PT-ASPECTS score was the main influencing factor of final infarct volume;pre-thrombectomy mRS score and PT-ASPECTS score were the main influencing factors of poor prognosis at discharge.Conclusion The hyperdensity revealed by NCCT immediately after mechanical thrombectomy maybe an independent predictors of final infarct volume and poor prognosis at discharge.This study may provide a simple and feasible early post-thrombectomy predictor for evaluating the short-term prognosis of patients with thrombectomy.