动态CT血管造影联合CT灌注成像评估预测急性缺血性脑卒中预后研究

Value of dynamic CTA combined with the assessment of CTP imaging in predicting the prognosis of acute ischemic stroke

目的:探讨动态CT血管造影(CTA)联合CT灌注成像(CTP)评估预测急性缺血性脑卒中(AIS)预后的价值。方法:选取141例AIS患者,根据预后情况分为预后良好组(106)和预后不良组(35例),比较两组患者临床基线资料、CTA及CTP参数差异,分析AIS患者预后不良因素,探讨CTA联合CTP预测AIS患者预后的价值。结果:预后不良组年龄>60岁比例明显高于预后良好患者,差异有统计学意义(x^(2)=6.671,P<0.05);预后不良组患者入院时美国国立卫生研究院卒中量表(NIHSS)评分及梗死面积明显高于预后良好患者,差异有统计学意义(t=12.096,t=10.706;P<0.05)。预后不良组ASPECTS侧支循环评分≤3分者显著高于预后良好组,差异有统计学意义(x^(2)=9.567,P<0.05)。预后不良组平均通过时间(MTT)、达峰时间(TTP)及相对平均通过时间(rMTT)明显高于预后良好患者,相对脑血容量(rCBV)明显低于预后良好患者,差异有统计学意义(t=6.395,t=6.395,t=3.379,t=-3.905;P<0.05)。Logistic回归分析显示,年龄、NIHSS评分、ASPECTS侧支循环评分≤3分、rCBV及rMTT是AIS预后不良的影响因素(OR=1.575,OR=1.855,OR=1.654,OR=0.717,OR=1.374;P<0.05)。ASPECTS侧支循环评分联合rCBV、rMTT预测患者预后不良的受试者工作特征(ROC)曲线下面积为0.820,显著高于ASPECTS侧支循环评分、r CBV及r MTT单独预测(x^(2)=5.543,x^(2)=6.832,x^(2)=6.172;P<0.05)。结论:CTA联合CTP在预测AIS预后方面有一定价值,其中ASPECTS侧支循环评分联合r CBV、r MTT预测患者预后不良价值较高。

Objective:To explore the application value of dynamic computed tomography angiography(CTA)combined with the assessment of CT perfusion(CTP)imaging in predicting the prognosis of acute ischemic stroke.Methods:A total of 141 patients with acute ischemic stroke were selected,and they were divided into favorable prognosis group(106 cases)and poor prognosis group(35 cases)according to the prognostic conditions of them.The differences of clinical baseline data,CTA and CTP parameters between two groups were compared.The factors of poor prognosis of patients with acute ischemic stroke were analyzed,and the value of CTA combined with CTP in predicting the prognosis of acute ischemic stroke was further explored.Results:The proportion of patients whose ages were over 60 years old in poor prognosis group was significantly higher than that in favorable prognosis group,and the difference was statistically significant(x^(2)=6.671,P<0.05).The score of national institute of health for stroke scale(NIHSS)and infarct size(IS)of patients with poor prognosis were significantly higher than those of patients with favorable prognosis at admission,with statistically significant differences(t=12.096,t=10.706,P<0.05),respectively.The number of ASPECTS collateral circulation≤3 score in the poor prognosis group was significantly higher than that in the favorable prognosis group,with a statistically significant difference(x^(2)=9.567,P<0.05).The MTT,TTP,and rMTT of the poor prognosis group were significantly higher than those of the favorable prognosis group,while rCBV of the former was significantly lower than that of the favorable prognosis group(t=6.395,t=6.395,t=3.379,t=-3.905,P<0.05),respectively.Logistic regression analysis showed that age,NIHSS score,ASPECTS collateral circulation score≤3 score,rCBV and rMTT were the influencing factors of poor prognosis of acute ischemic stroke(OR=1.575,OR=1.855,OR=1.654,OR=0.717,OR=1.374,P<0.05).The area under curve(AUC)of the receiver operating characteristic(ROC)curve of the combination of ASPECTS collateral circulation score,rCBV and rMTT was 0.820 in predicting the poor prognosis of patients,which was significantly higher than that of single prediction of ASPECTS collateral circulation score,rCBV and rMTT(x^(2)=5.543,x^(2)=6.832,x^(2)=6.172,P<0.05),respectively.Conclusion:CTA combined with CTP has a certain of application value in predicting the prognosis of acute ischemic stroke,and the ASPECTS collateral circulation score combined with rCBV and rMTT has a higher value in predicting poor prognosis of patients.