CT灌注成像在急性缺血性卒中患者诊断及预后评估中的应用

CT perfusion imaging in the diagnostic and prognostic evaluation of patients with acute ischemic stroke

目的探讨CT灌注成像在急性缺血性卒中(AIS)患者诊断及预后评估中的应用价值。方法回顾性研究。纳入2020年2月—2021年7月河南省直第三人民医院收治的AIS患者104例,其中,男61例、女43例,年龄46~81(62.7±12.3)岁。患者均接受急诊脑CT灌注成像检查,获取核心梗死面积,以及脑血流量(CBF)、脑血容量(CBV)、对比剂平均通过时间(MTT)和峰值时间(TTP)等CT灌注成像血流动力学参数,对比分析患者脑梗死区和缺血半暗带脑组织间CBF、CBV、MTT、TTP值的差异。以《中国急性缺血性脑卒中诊疗指南2018》为金标准,分析CT灌注成像AIS患者的检出率。入院时进行美国国立卫生研究院卒中量表(NIHSS)评分评估患者神经功能状态。治疗后3个月采用改良Rankin量表(mRS)评分评估患者预后,并按照预后评估结果进行分组观察。采用logistic回归分析AIS预后的预测因素。结果本组104例AIS患者中,经CT灌注成像检查显示梗死区及半暗带血流异常者共96例(检出率为92.31%)。CT灌注成像检出的96例中,mRS评分评估预后良好者69例、预后不良者27例。脑梗死区和缺血半暗带分别与健侧对应部位的正常脑组织相比,CBF、CBV值降低,MTT、TTP延长,差异均有统计学意义(P值均<0.05)。预后不良组核心梗死面积、发病至溶栓时间及高脂血症比例、NIHSS评分及缺血半暗带CT灌注参数MTT、TTP均高于预后良好组,CT灌注参数CBF、CBV均低于预后良好组,差异均有统计学意义(P值均<0.05)。logistic回归分析结果显示,核心梗死面积、发病至溶栓时间、高脂血症,NIHSS评分,以及缺血半暗带CT灌注成像血流动力学参数CBF、CBV、MTT、TTP等均是AIS患者预后的预测因素(P值均<0.05)。结论CT灌注成像检查可快速反映脑部组织灌注损伤情况,对AIS患者的及时诊断具有重要意义;且CT灌注成像血流动力学参数可有效反映AIS患者溶栓治疗后受累血管再通情况,为其预后评估提供一定依据。

Objective This work aimed to explore the value of CT perfusion imaging in the diagnostic and prognostic evaluation of patients with acute ischemic stroke(AIS).Methods A retrospective study was conducted on 104 patients with AIS treated in Henan No.3 Provincial People's Hospital from February 2020 to July 2021,a total of 61 males and 43 females,aged 46-81(62.7±12.3)years old.Cerebral CT perfusion imaging was performed urgently for all patients to obtain the related parameters such as core infarct size,cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT),and time to peak(TTP)of contrast agent.Using Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018 as the gold standard,the detection rate of CT perfusion imaging in patients with AIS was analyzed.The differences in CBF,CBV,MTT,and TTP between cerebral infarction area and ischemic penumbra were compared.At admission,the National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the neurological status of patients.The prognosis of the patients was assessed by modified Rankin scale(mRS)score 3 months after treatment,and the patients were divided into two groups based on the outcome of prognostic assessment.Multivariate logistic regression analysis was adopted to analyze the predictive factors of prognosis of AIS.Results A total of 96 patients with AIS showed blood flow in the infarcted area and penumbra by CT perfusion imaging,with the detection rate of 92.31%(96/104).A total of 69 patients with good prognosis and 27 patients with poor prognosis were assessed by mRS score.Compared with the contralateral normal cerebral tissue,the CBF and CBV decreased in the cerebral infarction region and ischemic penumbra region,whereas MTT and TTP were prolonged(all P values<0.05).The core infarct size,incidence of thrombolysis time and hyperlipidemia,NIHSS score,and CT perfusion parameters MTT and TTP in the ischemic penumbra were higher than those in the good prognosis group.The CT perfusion parameters CBF and CBV were lower in the ischemic penumbra than those in the good prognosis group(all P values<0.05).Multivariate logistic regression analysis showed that core infarct size,time from onset to thrombolysis,hyperlipidemia,NIHSS score,and hemodynamic parameters CBF,CBV,MTT,and TTP of CT perfusion imaging in ischemic penumbra were all predictive factors affecting the prognosis of patients with AIS(all P values<0.05).Conclusion CT perfusion imaging can quickly reflect the perfusion injury of brain tissue,and it is of great significance for the diagnosis of patients with AIS.The hemodynamic parameters of CT perfusion imaging can effectively reflect the recanalization of affected vessels in patients with AIS after thrombolytic therapy and provide a basis for prognostic evaluation.