一站式CTP对预测急性脑梗死患者预后的评估价值

Value of CT Perfusion in Predicting the Prognosis of Patients with Acute Cerebral Infarction

【目的】分析急性脑梗死患者治疗前一站式CT灌注成像(CTP)及治疗前后临床影像资料,明确与预后相关的临床及影像特征。【方法】纳入CT/MRI随访证实的39例急性脑梗死患者(男:女=21:18,平均年龄65岁,平均起病时间8.4 h),所有患者均随访90天获取其mRS评分(平均2.8分)。对上述患者行320排螺旋CT一站式CTP[非增强CT(NCCT)-CT血管成像(CTA)-CTP]扫描,对NCCT图像行ASPECTS(alberta stroke program early ct score)评分,经后处理获得脑血管图,脑梗死核心区、缺血半暗带体积以及其相应比值,并获得CTP各灌注参数图[CBF,CBV,MTT,TTP,延迟达峰时间(Delay-TTP)]。将大小一致的感兴趣区分别放置在脑梗死核心区、缺血半暗带及其相应对侧脑实质,分别测量3次,取平均值。【结果】39例患者中,20例预后良好(mRS≤2)。相关分析发现,治疗前后NIHSS评分、梗死核心体积、缺血半暗带MTT及相应区域Delay-TTP与随访90天mRS评分成明显正相关(P≤0.04);而治疗后ASPECTS评分及梗死核心区CBF值与90 d mRS评分成明显负相关(P<0.05)。进一步两组对比分析发现,治疗前后NIHSS、治疗后ASPECTS、CTP示梗死核心区体积及梗死核心CBF值与患者预后明显相关并具有统计学差异(P≤0.03)。ROC分析显示治疗后NIHSS评分对于预测急性脑梗死患者预后有着最高的诊断效能(AUC为0.90),其中敏感度、特异度及拐点值分别为79%,85%和4.5;而梗死核心区CBF具有最佳的特异度(89%),治疗后ASPECTS评分在预测预后方面具有最高的敏感度(94%)。【结论】急性脑梗死患者梗死核心区体积、CBF、治疗前后NIHSS及治疗后ASPECTS评分与患者的预后密切相关。相比较NIHSS评分,梗死核心区CBF对于预测急性脑梗死预后有着更高的特异度。

【Objective】To analyze the clinical data of CT perfusion imaging(CTP)before and after treatment in acute ischemia stroke(AIS)patients,and to identify the imaging and clinical features related to prognosis.【Methods】A total of 39 CT/MRI confirmed AIS patients(Male:Female=21:18,mean age:65 years,mean onset time:8.4 h)were prospec⁃tively included,and they were followed for 90 days to obtain their mRS score(mean 2.8).All patients underwent 320-row spiral CTP scan,and non-contrast CT(NCCT),CT angiography(CTA)and CT perfusion(CTP)were generated.AS⁃PECTS score and CTP perfusion parameters(CBF,CBV,MTT,TTP,Delay-TTP)were calculated.In addition,the vol⁃ume of cerebral ischemia core,ischemic penumbra and their ratio were obtained.Three ROIs with similar size were placed in the cerebral infarction core,ischemic penumbra and corresponding contralateral brain parenchyma,and all the parame⁃ters were measured three times respectively,to take the average value.【Results】Of 39 AIS patients,20 patients showed good prognosis(mRS≤2).Correlation analysis showed that NIHSS score,ischemia core volume,MTT and delayed-TTP in ischemic penumbra were significantly positively correlated with mRS scores at 90 days(P≤0.04),while the post-treat⁃ment ASPECTS and CBF in the ischemia core were significantly negatively correlated with mRS scores at 90 days(P<0.05).Further comparative analysis demonstrated that NIHSS score before and after treatment,ASPECTS after treatment and ischemia core volume and CBF in ischemia core were significantly different in AIS patients with good or bad prognosis(P≤0.03).ROC analysis showed that NIHSS score had the highest diagnostic value in predicting the prognosis of AIS pa⁃tients(AUC:0.90),and the sensitivity,specificity and cut-off values were 79%,85%and 4.5,respectively.CBF in the ischemia core had the best specificity(89%)and the post-treatment ASPECTS demonstrated the highest sensitivity(94%)in prognosis predicting of AIS patients.【Conclusions】Ischemia core volume,CBF,NIHSS score before and after treatment,and post-treatment ASPECTS of AIS patients are closely related with their prognosis.Compared with NIHSS score,the ischemia core CBF has a higher specificity in predicting the prognosis of AIS patients.