多时相CT血管造影及颅脑灌注在急性大脑中动脉脑卒中的价值研究

Study on the value of MP-CTA and cerebral CTP in AIS

目的:分析多时相CT血管造影(MP-CTA)及颅脑CT灌注(CTP)预测急性大脑中动脉脑卒中(AIS)患者侧支循环及预后的价值。方法:选取医院收治的100例急性大脑中动脉脑卒中患者,根据Alberta卒中项目早期CT评分(ASPECTS)将其分为侧支循环良好组(60例)和侧支循环不良组(40例),所有患者均行MP-CTA及CTP检查。采用美国国立卫生研究院卒中量表(NIHSS)评分,比较两组患者治疗前后神经功能缺损水平变化。根据改良的Rankin量表(mRS)评分将100例急性大脑中动脉脑卒中患者分为预后良好组(63例)及预后不良组(37例),比较两组脑血容量(CBV)、脑血流量(CBF)、达峰时间(TTP)、平均通过时间(MTT)水平,采用Spearman分析ASPECTS评分与CBV、CBF、MTT及mRS评分的相关性。采用受试者工作特征(ROC)曲线分析CTA及CTP在脑卒中患者预后评价中的价值。结果:侧支循环良好组和侧支循环不良组患者溶栓治疗24 h及2周后NIHSS评分均低于入院时,差异有统计学意义(F=93.282,F=15.381;P<0.05)。治疗后24 h及2周,侧支循环不良组NIHSS评分高于侧支循环良好组,差异有统计学意义(t=8.183,t=8.412;P<0.05);侧支循环不良组CBV、CBF及MTT高于侧支循环良好组,差异有统计学意义(t=4.818,t=4.820,t=4.185;P<0.05)。侧支循环良好组和侧支循环不良组患者的CBV、CBF及MTT水平与ASPECTS评分呈明显负相关(r=-0.516,r=-0.461,r=-0.517;P<0.05)。随访3个月后,侧支循环不良组mRS评分明显高于侧支循环良好组,差异有统计学意义(t=8.784,P<0.05)。侧支循环良好组和侧支循环不良组患者的ASPECTS评分与mRS评分呈明显负相关(r=-0.358,P<0.05)。预后不良组CBV、CBF及MTT明显高于预后良好组,差异具有统计学意义(t=4.924,t=4.463,t=4.434;P<0.05)。CBV、CBF和MTT诊断脑卒中患者预后的ROC曲线下面积(AUC)分别为0.665、0.751和0.701,ASPECTS评分和CTA联合CTP诊断脑卒中患者预后的AUC分别为0.812和0.893。结论:ASPECTS评分及CTP指标可有效评估患者的侧支循环状态及预后情况,有利于早期制定个体化治疗方案,以改善患者预后,可在临床中广泛应用。

Objective:To analyze the value of multiphase computed tomography angiography(MP-CTA)and cerebral computed tomography perfusion(CTP)in predicting collateral circulation and prognosis of patients with acute ischemic stroke(AIS).Methods:100 AIS patients who admitted to hospital were selected.They were divided into good collateral circulation group(60 cases)and poor collateral circulation group(40 cases)according to the Alberta stroke project early CT scores(ASPECTS),and all patients underwent MP-CTA and CTP examinations.The National Institutes of Health Stroke Scale(NIHSS)was used to compare the changes of neurological deficits of two groups between before and after treatment.In addition,100 AIS patients were further divided into favorable prognosis group(63 cases)and unfavorable prognosis group(37 cases)according to Modified Rankin Scale(MRS)score,and the levels of cerebral blood volume(CBV),cerebral blood flow(CBF),time to peak(TTP)and mean transit time(MTT)were compared between the two groups.The Spearman analysis was used to analyze the correlations between ASPECTS score and CBV,CBF,MTT and mRS scores,respectively.Receiver operating characteristics(ROC)curve was used to analyze the values of CTA and CTP in the prognosis evaluation of patients with stroke.Results:The NIHSS scores of patients with good collateral circulation and patients with poor collateral circulation after thrombolytic therapy for 24 hours and for 2 weeks were significantly lower than those at admission,and the differences of them were statistically significant(F=93.282,F=15.381,P<0.05).After treatment for 24 hours and 2 weeks,the NIHSS score of poor collateral circulation group was significantly higher than that of good collateral circulation group(t=8.183,t=8.412,P<0.05),respectively.The CBV,CBF and MTT of poor collateral circulation group were significantly higher than those of good collateral circulation group(t=4.818,t=4.820,t=4.185,P<0.05).The levels of CBV,CBF and MTT of good collateral circulation group and poor collateral circulation group appeared significantly negative correlation with ASPECTS scores(r=-0.516,r=-0.461,r=-0.517,P<0.05),respectively.After 3 months of followup,the mRS score of poor collateral circulation group was significantly higher than that of good collateral circulation group(t=8.784,P<0.05).There was a significant negative correlation between ASPECTS score and mRS score in good collateral circulation group and in poor collateral circulation group(r=-0.358,P<0.05).The CBV,CBF and MTT in unfavorable prognosis group were significantly higher than those in favorable prognosis group(t=4.924,t=4.463,t=4.434,P<0.05).The area under curves(AUCs)of ROC curve of CBV,CBF and MTT in diagnosing the prognosis of patients with stroke were 0.665,0.751 and 0.701,respectively.And the AUCs of the ASPECTS score,and the combination of CTA and CTP in diagnosing the prognosis of patients with stroke were 0.812 and 0.893,respectively.Conclusion:Both ASPECTS score and CTP index can effectively assess the collateral circulation status and prognosis of patients,which is conducive to early formulate individualized treatment scheme so as to improve the prognosis of patients,and it can be widely used in clinical practice.