脑皮质静脉显影评分评估皮质静脉充盈的优化与探讨

The Optimization Evaluation of Cortical Vein Filling by Cortical Vein Opacification Score

目的探讨改良脑皮质静脉显影评分(cortical vein opacification score,COVES)对大脑中动脉(middle cerebral artery,MCA)供血区引流皮质静脉充盈程度的评估。方法回顾性连续纳入2019年12月-2021年9月于濮阳市人民医院进行了头颈CTA和CTP检查并显示病灶侧MCA狭窄的缺血性卒中患者。收集患者的临床资料、病灶侧和对侧的CTP脑灌注指标[达峰时间(time to peak,TTP)、脑血流量(cerebral blood flow,CBF)、脑血容量(cerebral blood volume,CBV)]。基于CTA进行皮质静脉充盈程度的评估,单支静脉不显影为0分,部分显影为1分,完全显影为2分。COVES评分包括病灶侧大脑中浅静脉、蝶顶窦和下吻合静脉的总分;改良COVES评分包括病灶侧的上吻合静脉、下吻合静脉和蝶顶窦的总分。通过ROC曲线及AUC分析改良COVES和COVES预测脑灌注不同指标(TTP、CBF、CBV)异常的敏感度及特异度。比较改良COVES和COVES对脑灌注异常的预测价值。结果共纳入55例缺血性卒中患者,年龄20~79岁,中位年龄58.5岁,男性34例(61.8%)。COVES≤2分时,预测TTP异常的敏感度为50.0%,特异度为95.2%;预测CBF异常的敏感度为47.2%,特异度为94.7%;预测CBV异常的敏感度为45.5%,特异度为86.4%。改良COVES≤3分时,预测TTP异常的敏感度为70.6%,特异度为95.2%;预测CBF异常的敏感度为66.7%,特异度为94.7%;预测CBV异常的敏感度为66.7%,特异度为86.4%。改良COVES、COVES预测TTP异常的AUC分别为0.845、0.735,差异有统计学意义(P=0.039)。结论改良COVES评估脑皮质引流静脉充盈程度、脑灌注的价值优于COVES。

Objective To explore the value of the modified cortical vein opacification score(COVES)in evaluating the filling degree of draining cortical venous in middle cerebral artery(MCA)territory.Methods This retrospective study included ischemic stroke patients due to MCA stenosis who underwent head and neck CTA and brain CTP in Puyang People’s Hospital from December 2019 to September 2021.The clinical data and indicators of bilateral cerebral CT perfusion[time to peak(TTP),cerebral blood flow(CBF),cerebral blood volume(CBV)]were collected.The modified COVES based on CTA was used to evaluate the filling degree of cortical veins as follows:0,not visible;1,moderate opacification;2,full opacification.The COVES score was the sum of scores of lesion ipsilateral superficial middle cerebral veins,sphenoparietal sinus and vein of Labbe;the modified COVES score was the sum of scores of vein of Trolard,vein of Labbe and sphenoparietal sinus.The area under the ROC curve(AUC)was used to analyze the value of modified COVES and COVES in evaluating cerebral perfusion,and compared their difference(TTP,CBF,CBV).Results A total of 55 ischemic stroke patients were included,with an average age of 58.5(range:20-79 years)years old and 34 males(61.8%).For COVES≤2 in predicting abnormal TTP,the sensitivity was 50.0%and the specificity was 95.2%;for abnormal CBF,the sensitivity was 47.2%and the specificity was 94.7%;for abnormal CBV,the sensitivity was 45.5%and the specificity was 86.4%.For modified COVES≤3 in predicting abnormal TTP,the sensitivity was 70.6%and the specificity was 95.2%;for abnormal CBF,the sensitivity was 66.7%and the specificity was 94.7%;for abnormal CBV,the sensitivity was 66.7%and the specificity was 86.4%.The AUC of modified COVES and COVES in predicting abnormal TTP was 0.845 and 0.735,respectively(P=0.039).Conclusions Modified COVES was superior to COVES in evaluating the filling degree of draining cortical venous and cerebral perfusion.