CT脑灌注成像在急性脑梗死溶栓后出血转化中的预测价值及参数分析

The predictive value and parameter analysis of CT cerebral perfusion imaging in the transformation of hemorrhage after thrombolysis in acute cerebral infarction

目的:分析CT脑灌注成像在急性脑梗死(ACI)溶栓后出血转化中的预测价值及有关参数。方法:选取2021年4月—2023年4月济南市中西医结合医院收治的96例行溶栓治疗的ACI患者,根据7 d内头颅CT结果将患者分为出血转化组(31例)与非出血转化组(65例),对比两组CT灌注成像有关参数[相对脑血流量(rCBF)、相对脑血容量(rCBV)、相对达峰时间(rTTP)]的差异;另绘制受试者工作特征(ROC)曲线,分析CT灌注成像有关参数单独及联合预测ACI患者溶栓后出血转化的价值。结果:出血转化组的rCBF、rCBV低于非出血转化组,rTTP高于非出血转化组,差异有统计学意义(P<0.05);ROC曲线结果显示:rCBF、rCBV、rTTP联合预测ACI溶栓后出血转化的曲线下面积(AUC)为0.936(95%CI:0.868~1.000),高于三者单独预测的0.845(95%CI:0.755~0.935)、0.872(95%CI:0.792~0.952)、0.833(95%CI:0.735~0.931)。结论:CT脑灌注成像在ACI溶栓后出血转化预测中作用明显,可为临床提供一定的参考信息。

Objective To analyze the predictive value and related parameters of CT cerebral perfusion imaging in the transformation of hemorrhage after thrombolysis in acute cerebral infarction(ACI).Methods 96 ACI patients treated with thrombolysis in Jinan Hospital of Integrated Chinese and Western Medicine,from April 2021 to April 2023 were selected and divided into a hemorrhage conversion group(31 cases)and a non hemorrhage conversion group(65 cases)based on their head CT results within 7 days.The differences in CT perfusion imaging parameters(relative cerebral blood flow(rCBF),relative cerebral blood volume(rCBV),and relative peak time(rTTP))between the two groups were compared;Additionally,draw a receiver operating characteristic(ROC)curve to analyze the value of CT perfusion imaging parameters alone and in combination in predicting the transformation of hemorrhage in ACI patients after thrombolysis.Results rCBF and rCBV in hemorrhage conversion group were lower than those in non-hemorrhage conversion group,and rTTP was higher than that in non-hemorrhage conversion group,the difference was statistically significant(P<0.05).ROC curve results show:The area under the curve(AUC)of the combined prediction of rCBF,rCBV and rTTP after ACI thrombolysis was 0.936(95%CI:0.868~1.000).It is higher than 0.845(95%CI:0.7555~0.935),0.872(95%CI:0.792~0.952)and 0.833(95%CI:0.735~0.931)predicted by the three separately.Conclusions CT cerebral perfusion imaging plays a significant role in predicting the transformation of hemorrhage after ACI thrombolysis,and can provide certain reference information for clinical practice.