基于全脑灌注容积数据重建动态CTA对缺血性脑卒中侧支循环的评估价值分析

Analysis of the evaluation value of dynamic CTA reconstruction for collateral circulation in ischemic stroke based on total cerebral perfusion volume data

目的分析基于全脑灌注(CTP)容积数据重建动态CT血管成像(CTA)对缺血性脑卒中(AIS)侧支循环的评估价值。方法选取92例AIS患者(发病时间<6 h)的临床资料,均行全脑动态容积CTA-CTP检查。统计动态CTA下AIS侧支循环情况,分析侧支循环情况与梗死的相关性,并比较侧支循环良好与侧支循环不良组间灌注参数的差异情况。结果92例AIS患者均得到了良好的动态CTA图像,其中61例侧支循环良好(66.3%),31例侧支循环差(33.7%),每例患者头颅平扫及CTA-CTP检查的总辐射剂量范围为4.98~6.24 mSv,平均为5.87 mSv;CTA侧支循环评分与入院时基线梗死体积、低灌注区体积(Tmax>6 s)、严重低灌注区体积(Tmax>12 s)、核心梗死区不匹配比值及最终梗死体积呈负相关(r值分别为-0.469、-0.314、-0.429、-0.308、-0.445,P值分别为0.005、0.040、0.009、0.038、0.007);侧支循环不良组梗死核心体积(CVB<2 ml/100 g体积)、低灌注(Tmax>6 s)及严重低灌注区体积(Tmax>12 s)明显高于侧支循环良好组(均P<0.05),Tmax、HIR更大(均P<0.05),而侧支循环不良组核心梗死区与低灌注区不匹配比、rCBF、rCBV、rMTT值明显低于侧支循环良好组(均P<0.05)。结论基于全脑灌注容积数据重建动态CTA可较好地评估AIS患者侧支循环状态,可辅助预测临床预后。

Objective To analyze the value of dynamic CT angiography(CTA)based on total cerebral perfusion(CTP)volume data in the evaluation of collateral circulation in ischemic stroke(AIS).Methods Clinical data of 92 patients with AIS admitted to the Department of Neurology were collected,and the dynamic volume CTA-CTP of the whole brain was performed.Statistics of AIS collateral circulation under dynamic CTA were performed to analyze the correlation between collateral circulation and infarction,and to compare the differences in perfusion parameters between groups with good collateral circulation and poor collateral circulation.Results Good dynamic CTA images were obtained in all the 92 patients with AIS,including 61 patients with good collateral circulation(66.3%)and 31 patients with poor collateral circulation(33.7%).The total radiation dose range of cranial flat scan and CTA-CTP examination for each patient was 4.98~6.24 mSv,with an average of 5.87 mSv;CTA collateral circulation score was negatively correlated with baseline infarction volume,low perfusion area volume(Tmax>6 s),severe low perfusion area volume(Tmax>12 s),core infarction mismatching ratio,and final infarction volume at admission(r values were-0.469,-0.314,-0.429,-0.308,-0.445,P values were 0.005,0.040,0.009,0.038,and 0.007);A core group of bad circulation infarction volume(CVB<2 ml/100 g)volume,low perfusion(Tmax>6 s)and severe low perfusion volume(Tmax>12 s)volume was significantly higher than good collateral circulation group(all P<0.05),Tmax,HIR greater(all P<0.05),while bad core set collateral circulation infarction area and low perfusion area didn't match ratio,rCBF,rCBV,of rMTT value was lower than that in group a good collateral circulation(all P<0.05).Conclusion Dynamic CTA reconstruction based on the whole brain perfusion volume data can better evaluate the collat eral circulation status of AIS patients and assist to predict the clinical prognosis.