CT灌注成像参数在预测急性脑梗死溶栓后出血转化中的价值

Value of CT perfusion in predicting hemorrhagic transformation in acute ischemic cerebral infarction patients after thrombolysis

目的探讨CT灌注成像(CTP)预测急性脑梗死溶栓治疗后发生出血转化(HT)风险的价值。方法回顾性的收集我院急诊收入神经内科的急性脑梗死患者58例,按照7 d内随访头颅CT结果分为出血组23例及未出血组35例,采用美国国立卫生研究院卒中量表(NIHSS)评分,使用改良的Rankin量表(mRS)评估治疗后90 d的神经功能。收集CTP相关参数:相对脑血容量(rCBV)、相对脑血流量(rCBF)、相对达峰时间(rTTP)等。结果出血组NIHSS评分、90 d预后不良比例、rTTP缺损区发生率明显高于未出血组(P<0.05,P<0.01),rCBF及rCBV明显低于未出血组(0.19±0.08 vs 0.26±0.09,P=0.009;0.53±0.17 vs 0.69±0.21,P=0.002)。rCBV预测HT风险的ROC曲线下面积(AUC)为0.746(95%CI:0.620~0.872),临界值为62.5%,敏感性为0.739,特异性为0.714。rCBF预测HT风险的AUC为0.719(95%CI:0.580~0.858)。结论CTP可早期显示急性缺血脑组织的血流动力学状况,对预测HT发生风险有重要的临床意义。

Objective To study the value of CT perfusion in predicting the risk of hemorrhagic transformation in acute ischemic cerebral infarction patients after thrombolysis.Methods Fiftyeight acute ischemic cerebral infarction patients admitted to our hospital were divided into hemorrhage group(n=23)and hemorrhage-free group(n=35).Their neurological function was assessed according to their NIHSS and mRS scores after 90 days of treatment.Their CT perfusion parameters(rCBF,rCBV and rTTP)were recorded.Results The NIHSS score,rate of poor outcome and incidence of acute ischemic cerebral infarction in rTTP defective region were significantly higher(P<0.05,P<0.01)while the rCBF and rCBV were significantly larger in hemorrhage group than in hemorrhage-free group(0.19±0.08 vs 0.26±0.09,P=0.009;0.53±0.17 vs 0.69±0.21,P=0.002).The AUC for rCBV in predicting the risk of hemorrhagic transformation was 0.746(95%CI:0.620-0.872)with a cut-off value of 62.5%,a sensitivity of 0.739 and a specificity of 0.714.The AUC for rCBF in predicting the risk of hemorrhagic transformation was 0.719(95%CI:0.580-0.858).Conclution CT perfusion can show the hemodynamic state in early acute ischemic brain tissue and plays an important role in predicting the risk of hemorrhagic transformation in acute ischemic cerebral infarction patients.