CT灌注成像联合CT血管造影对急性前循环脑梗死患者发生早期神经功能恶化的预测价值

Predictive Value of CT Perfusion Imaging Combined with CT Angiography for Early Neurological Deterioration in Patients with Acute Anterior Circulation Brain Infarction

目的分析CT灌注成像(CTP)联合CT血管造影(CTA)对急性前循环脑梗死患者发生早期神经功能恶化(END)的预测价值。方法选取2020年5月至2022年5月太和县人民医院收治的急性前循环脑梗死患者80例。根据患者是否发生END将其分为END组(n=19)与无END组(n=61)。采用CTP检测患者缺血区脑血流量(CBF)、脑血容量(CBV)、达峰时间(TTP)面积,采用CTA评估患者侧支循环情况。绘制ROC曲线以分析CTP、CTA检查指标及其联合对急性前循环脑梗死患者发生END的预测价值。结果END组缺血区CBF、CBV、TTP面积大于无END组,侧支循环不良发生率高于无END组(P<0.05)。ROC曲线分析结果显示,缺血区CBF、CBV、TTP面积及侧支循环不良单独预测急性前循环脑梗死患者发生END的AUC分别为0.742〔95%CI(0.615,0.870)〕、0.660〔95%CI(0.499,0.821)〕、0.792〔95%CI(0.678,0.906)〕、0.696〔95%CI(0.544,0.847)〕,四者联合预测急性前循环脑梗死患者发生END的AUC为0.909〔95%CI(0.837,0.982)〕。结论CTP、CTA检查指标(缺血区CBF、CBV、TTP面积及侧支循环不良)联合对急性前循环脑梗死患者发生END的预测价值较高。

Objective To analyze the predictive value of CT perfusion imaging(CTP)combined with CT angiography(CTA)for early neurological deterioration(END)in patients with acute anterior circulation cerebral infarction.Methods A total of 80 patients with acute anterior circulation brain infarction admitted to Taihe County People's Hospital from May 2020 to May 2022 were selected.Patients were divided into END group(n=19)and non-END group(n=61)according to whether END occurred.The area of cerebral blood flow(CBF),cerebral blood volume(CBV)and time to peak(TTP)in ischemic area were detected by CTP,and collateral circulation was evaluated by CTA.ROC curve was drawn to analyzed the predictive value of CTP,CTA examination indexes and their combination for END in patients with acute anterior circulation cerebral infarction.Results The area of CBF,CBV and TTP in ischemic area in END group was larger than that in non-END group,and the incidence of poor collateral circulation was higher than that in non-END group(P<0.05).ROC curve analysis showed that the AUC of area of CBF,CBV and TTP in ischemic area and poor collateral circulation alone in predicting END in patients with acute anterior circulation cerebral infarction was 0.742[95%CI(0.615,0.870)],0.660[95%CI(0.499,0.821)],0.792[95%CI(0.678,0.906)],0.696[95%CI(0.544,0.847)],respectively.The AUC of their combination in predicting END in patients with acute anterior circulation cerebral infarction was 0.909[95%CI(0.837,0.982)].Conclusion The combination of CTP,CTA examination indexes(area of CBF,CBV and TTP in ischemic area and poor collateral circulation)has a higher predictive value for END in patients with acute anterior circulation cerebral infarction.