CT灌注成像对急性大核心脑梗死早期血管内治疗效果的预测效能

Value of CT perfusion in predicting clinical outcome of early endovascular treatment for acute ischemic stroke with large ischemic core

目的分析CT灌注成像对急性大核心脑梗死早期血管内治疗效果的预测效能。方法选择2018年10月至2022年11月在浙江省人民医院接受早期血管内治疗的急性大核心脑梗死患者54例,根据术后90 d改良Rankin量表(mRS)评分将患者分为预后良好组(观察组)23例和预后不良组(对照组)31例。收集并比较两组患者的一般资料及CT灌注成像等资料。采用多因素logistic回归分析CT灌注成像与急性大核心脑梗死早期血管内治疗临床预后的相关性。采用ROC曲线分析CT灌注成像对急性大核心脑梗死早期血管内治疗效果的预测效能。结果观察组NIHSS评分低于对照组,不匹配率高于对照组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,NIHSS评分和不匹配率均是急性大核心脑梗死早期血管内治疗预后的影响因素(均P<0.05)。ROC曲线显示,不匹配率预测急性大核心脑梗死早期血管内治疗预后良好的AUC为0.660(95%CI:0.509~0.811,P=0.046),最佳截断值为2.30,灵敏度为0.696,特异度为0.645。结论CT灌注成像与急性大核心脑梗死早期患者血管内治疗临床预后密切相关,有一定的预测效能。

Objective To explore the predictive value of CT perfusion in the early endovascular treatment of acute ischemic stroke with large ischemic core.Methods Fifty-four acute ischemic stroke patients with large ischemic core underwent early endovascular treatment in Zhejiang Provincial People's Hospital from October 2018 to November 2022 were enrolled.According to the modified Rankin scale(mRS)score 90 days after operation,the patients were divided into good outcomes group(n=23)and poor outcomes group(n=31).The general clinical data and CT perfusion imaging of the two groups were collected and compared.Multivariate logistic regression analysis was used to explore the correlation between CT perfusion imaging and clinical outcomes of endovascular treatment for acute ischemic stroke with large ischemic core.ROC curve was used to analyze the value of CT perfusion imaging in predicting the prognosis of endovascular treatment for acute ischemic stroke with large ischemic core.Results NIHSS score in the observation group was lower than that of the control group,and the mismatch rate in observation group was significantly compared with the control group(both P<0.05).Multivariate logistic regression analysis showed that NIHSS score and mismatch rate were independently associated with good outcomes of endovascular treatment for acute ischemic stroke with large ischemic core(both P<0.05).The ROC curve showed that the AUC of mismatch rate for predicting good outcomes of endovascular treatment for acute ischemic stroke with large ischemic core was 0.660(95%CI:0.509-0.811,P=0.046),with the optimal cutoff value of 2.30,the sensitivity of 0.696,and the specificity of 0.645.Conclusion CT perfusion imaging is closely related to the clinical outcomes of endovascular treatment for acute ischemic stroke with large ischemic core,and may be predictive for good clinical outcomes.