CTA和CTP评估急性缺血性脑卒中侧支循环状态及与预后的关系

CTA and CTP in evaluating collateral circulation status of acute ischemic stroke and relationship with prognosis

目的 探讨CT动脉血管成像(CTA)和CT灌注成像(CTP)在急性缺血性脑卒中(AIS)侧支循环及预后评估中的应用价值。方法 回顾性分析2020-01—2023-06广元市中心医院96例AIS患者的临床资料,患者入院后均行CTA及CTP检查,基于CTA图像分为侧支循环良好组和不良组,比较2组CTP参数值[相对脑血流量(rCBF)、相对脑血容量(rCBV)、相对对比剂峰值时间(rTTP)、相对平均通过时间(rMTT)],采用Spearman相关分析侧支循环评分与CTP参数值的相关性。随访3个月,依据改良Rankin量表(mRS)评分将患者分为预后良好组和预后不良组,比较2组临床资料及影像学结果,采用多因素Logistic回归分析AIS预后的影响因素。结果 96例患者CTA评估侧支循环良好组63例(65.63%),侧支循环不良组33例(34.37%)。侧支循环良好组rCBF、rCBV较侧支循环不良组高(P<0.05),rTTP、rMTT较侧支循环不良组低(P<0.05)。rCBF、rCBV均与CTA侧支循环评分呈正相关(r=0.472、0.518,P<0.01),rTTP、rMTT均与CTA侧支循环评分呈负相关(r=-0.502、-0.496,P<0.01)。预后良好组60例(62.50%),预后不良组36例(37.50%)。预后不良组NIHSS评分、合并冠心病比例、合并房颤比例、核心梗死体积、侧支循环不良比例、rTTP及rMTT值均高于预后良好组(P<0.05),rCBF、rCBV值均低于预后良好组(P<0.05)。多因素Logistic回归分析显示,NIHSS评分、合并房颤、核心梗死体积、侧支循环不良、rTTP及rMTT值均是患者预后不良的危险因素(P<0.05),rCBF、rCBV值是其保护因素(P<0.05)。结论 CTA能直观显示AIS患者侧支循环状态,CTP参数与侧支循环评分表现出相关性,能间接反映患者侧支循环状态,CTA、CTP检查均可为患者预后评估提供参考。

Objective To investigate the application value of CT angiography(CTA)and CT perfusion imaging(CTP)on the evaluation of collateral circulation and the prognosis of acute ischemic stroke(AIS).Methods The clinical data of 96 patients with AIS in Guangyuan Central Hospital from January 2020 to June 2023 were retrospectively analyzed.All patients underwent CTA and CTP after admission,and were divided into(good collateral circulation group and poor collateral circulation group based on CTA images.The CTP parameters relative cerebral blood flow(rCBF),relative cerebral blood volume(rCBV),relative time to peak(rTTP),relative mean transit time(rMTT))were compared between both groups.Spearman correlation analysis was used to analyze the correlation between collateral circulation score and CTP parameters.The patients were followed up for 3 months and classified into good prognosis group and poor prognosis group according to modified Rankin scale(mRS),and the clinical data and imaging results of the two groups were compared.The influencing factors for AIS prognosis were analyzed by using multivariate Logistic regression analysis.Results Among the 96 patients,CTA evaluated that 63 cases(65.63%)were in good collateral circulation group and 33 cases(34.37%)were in poor collateral circulation group.rCBF and rCBV in good collateral circulation group were higher(P<0.05),while rTTP and rMTT were shorter compared to poor collateral circulation group(P<0.05).Both rCBF and rCBV were positively correlated with CTA collateral circulation score(r=0.472,0.518,P<0.01),while both rTTP and rMTT were negatively correlated with CTA collateral circulation score(r=-0.502,-0.496,P<0.01).Among the 96 patients,there were 60 cases(62.50%)of good prognosis and 36 cases(37.50%)of poor prognosis.The NIHSS score,proportion of coronary heart disease,proportion of atrial fibrillation,volume of core infarction,proportion of poor collateral circulation,rTTP and rMTT in poor prognosis group were higher than those in good prognosis group(P<0.05),while the rCBF and rCBV were lower compared with those in good prognosis group(P<0.05).Multivariate Logistic regression analysis revealed that NIHSS score,atrial fibrillation,core infarction volume,poor collateral circulation,and rTTP were all risk factors for poor prognosis(P<0.05),and rCBF and rCBV were protective factors(P<0.05).Conclusion CTA can visually display the collateral circulation status in patients with AIS,and CTP parameters are correlated with collateral circulation score,which can indirectly reflect the status of collateral circulation of patients.Both CTA and CTP can provide reference for the prognosis assessment of patients.