一站式全脑CT灌注成像在急性缺血性脑卒中患者预后评估中的应用价值

The value of one-stop-shop whole-brain CT perfusion imaging for predicting outcome of patients with acute ischemic stroke

目的探究一站式全脑CT灌注成像(CTP)在急性缺血性脑卒中(AIS)患者预后评估中的应用价值。方法选择2018年12月至2021年3月海盐县人民医院收治并行一站式全脑CTP检查的AIS患者100例。治疗90 d后根据改良Rankin量表(mRS)评分分成预后良好组54例和预后不良组46例。采用Alberta卒中项目早期CT评分(ASPECTS)、美国介入和治疗神经放射学学会/介入放射学学会(ASITN/SIR)侧支循环分级分别评估脑梗死体积和梗死区域的侧支循环状况。检测并计算相对脑血流量(rCBF)、相对脑血容量(rCBV)、相对平均通过时间(rMTT)和相对达峰时间(rTTP)。结果预后不良组患者的rMTT和rTTP均高于预后良好组患者,ASPECTS 8分及以上人数、ASTIN/SIR侧支循环分级3级及以上人数、rCBF和rCBV均低于预后良好组患者,差异均有统计学意义(均P<0.05)。ASPECTS、ASITN/SIR侧支循环分级、rCBF、rCBV与AIS患者治疗90d后的mRS评分均呈负相关,rMTT、rTTP与其呈正相关,差异均有统计学意义(均P<0.05)。ASPECTS、ASITN/SIR侧支循环分级、rCBF和rCBV均是AIS患者预后评估的独立危险因素(均P<0.05)。这4项指标联合评估AIS患者预后的AUC、灵敏度、特异度均高于4项指标单独的评估价值。结论一站式全脑CTP检查有助于对AIS患者的预后的预判。

Objective To explore the value of one-stop-shop whole-brain CT perfusion imaging(CTP)for predicting outcome of patients with acute ischemic stroke(AIS).Methods A total of 100 AIS patients admitted to Haiyan People's Hospital from December 2018 to March 2021 and underwent one-stop-shop whole-brain CTP were selected.The patients were divided into good outcome group and poor outcome group based on modified Rankin scale(mRS)90 days later after treatment.Alberta stroke program early CT score(ASPECTS)and American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology(ASITN/SIR)collateral score were used to evaluate the cerebral infarction volume and collateral circulation status in the infarcted area,respectively.The relative cerebral blood flow(rCBF),relative cerebral blood volume(rCBV),relative mean transit time(rMTT)and relative peak time(rTTP)were measured and calculated.Results rMTT and rTTP were significantly higher in poor outcome group than in good outcome group(all P<0.05).The number of patients with ASPECTS score 8 or above and ASTIN/SIR collateral score 3 or above,rCBF and rCBV were significantly lower in poor outcome group than in good outcome group(all P<0.05).ASPECTS,ASITN/SIR collateral score,rCBF and rCBV were negatively correlated with mRS score,while rMTT and rTTP were positively correlated with mRS score of AIS patients 90 days later after treatment(all P<0.05).ASPECTS,ASITN/SIR collateral score,rCBF and rCBV were independent risk factors for the prognosis of AIS patients(all P<0.05).The AUC,sensitivity and specificity of the combination of the four parameters to evaluate the prognosis of AIS patients were higher than those of these parameters alone.Conclusion One-stop-shop whole-brain CTP is useful to predict the prognosis of AIS patients.