症状性后循环卒中侧支循环与CT脑灌注、临床预后相关性分析

Correlation between collateral circulation and cerebral perfusion and functional prognosis in patients with symptomatic posterior circulation stroke

目的:探讨症状性后循环卒中患者侧支循环与后循环急性卒中预后早期CT评分(pc-ASPECTS)、脑灌注及神经功能预后的关系。方法:回顾性纳入2019年7月—2021年12月间症状为眩晕呕吐、头晕头痛及行走不稳且临床诊断后循环缺血后经颅脑CT灌注成像(CTP)及头颈CT血管成像(CTA)一站式检查提示后循环灌注减低的患者76例,收集一般资料及影像学信息,进行多时相侧支循环评分、pc-ASPECTS、改良的Rankin量表(mRS)评分,灌注参数设定为局部脑血流量(rCBF)<30%对侧正常,残余功能达峰时间(Tmax)>6.0 s分别是梗死核心和缺血半暗带阈值计算相应体积。采用Spearman相关分析侧支循环评分与pc-ASPECTS、灌注参数、mRS评分的关系。结果:共纳入患者76例,平均年龄(65.01±11.28)岁,男55例(72.4%)。侧支循环评分与缺血半暗带体积(r=-0.423,P<0.001)、梗死体积(r=-0.397,P<0.001)呈负相关。侧支循环评分与pc-ASPECTS呈正相关(r=0.554,P<0.001)。侧支循环评分与mRS评分呈负相关(r=-0.375,P=0.001)。结论:后循环卒中患者多时相CTA侧支循环与脑缺血状态及临床预后相关。

Objective:To investigate the relationship between collateral circulation scores and posterior-circulation acute stroke prognosis early computed tomography score(pc-ASPECTS),cerebral perfusion,and functional prognosis in patients with symptomatic posterior circulation infarction.Methods:This study included 76 patients of posterior circulation ischemia,whose symptoms were vertigo,vomiting,dizziness,headache,and unsteady gait from July 2019 to December 2021.One-stop computed tomography perfusion(CTP)combined with computed tomography angiography(CTA)were performed.The collected data included general information,imaging results,collateral circulation scores in multiparametric CT imaging,pc-ASPECTS,and modified Rankin scale(mRS)scores.The corresponding volumes were calculated by setting regional cerebral blood flow(rCBF)<30%normal contralateral side as the infarct core and setting time to maximum(Tmax)>6.0 s as ischemical penumbra thresholds.Spearman correlation was used to analyze the relationship of the collateral circulation scores and pc-ASPECTS,perfusion parameters,and mRS scores.Results:A total of 76 cases with a mean age of(65.01±11.28)years and 55 males(72.4%)were included.Collateral circulation was positively correlated with pc-ASPECTS(r=0.554,P<0.001),collateral circulation scores were negatively correlated with penumbra volume(r=-0.423,P<0.001),and infarct volume(r=-0.397,P<0.001).Collateral circulation was negatively correlated with mRS scores(r=-0.375,P=0.001).Conclusions:Collateral circulation on multi-phase CTA in patients with posterior circulation stroke is related to cerebral ischemia and clinical prognosis.