多模式CT对急性前循环缺血性脑卒中患者缺血半暗带、梗死核心变化及预后的评估

Evaluation of ischemic penumbra,infarct core changes and prognosis in patients with acute anterior circulation ischemic stroke by multimodal CT

目的 探讨多模式CT对急性前循环缺血性脑卒中患者缺血半暗带、梗死核心变化及预后的评估。方法 回顾性选取2021年1月至2023年6月来佛山市中医院诊治的疑似急性前循环缺血性脑卒中患者100例,治疗前后分别行多模式CT检查。分析头颅CT平扫(NCCT)、CT灌注成像(CTP)、CT血管成像(CTA)结果。比较急性前循环缺血性脑卒中患者缺血半暗带区、梗死核心区患侧与健侧的脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)、达峰时间(TTP)值;比较治疗前后急性前循环缺血性脑卒中患者缺血半暗带的灌注参数[相对脑血容量(rCBV)、相对脑血流量(rCBF)、相对平均通过时间(rMTT)和相对达峰时间(rTTP)];比较治疗前后急性前循环缺血性脑卒中患者梗死核心的灌注参数(rCBF、rCBV、rTTP、rMTT);分析脑组织异常灌注与血管狭窄的相关性。43例急性前循环缺血性脑卒中患者根据发病4.5~9.0 h内经溶栓治疗结果,比较预后良好(改良Rankin评分≤2分,n=28)与预后不良(改良Rankin评分>2分,n=15)缺血半暗带的rCBV、rCBF、rMTT、rTTP值。结果 100例疑似患者经NCCT检查发现,59例患者可见早期的低密度病灶,其余41例患者未见明显异常,NCCT阳性率为59.00%。CTP检查结果发现,100例患者中9例经过CTP检查灌注正常,其余91例患者脑灌注均有异常现象,与临床症状相符,CTP检查发现阳性率为91.00%。CTA检查结果发现,存在责任血管狭窄或闭塞者88例,无存在责任血管狭窄或闭塞者12例。多模式CT结果:急性前循环缺血性脑卒中缺血半暗带区健侧、患侧CBV比较,差异无统计学意义(P>0.05),患侧的CBF明显较健侧低,患侧的MTT、TTP明显较健侧高,差异均有统计学意义(P<0.05)。梗死核心区患侧的CBV、CBF明显较健侧低,MTT、TTP明显较健侧高,差异均有统计学意义(P<0.05)。与梗死核心区相比,缺血半暗带的rCBV、rCBF明显较高,rMTT、rTTP值明显较低,差异均有统计学意义(P<0.05)。治疗后,前缺血半暗带rCBV与治疗前比较,差异无统计学意义(P>0.05),rCBF较治疗前高,rMTT、rTTP较治疗前低,差异均有统计学意义(P<0.05)。血流灌注异常者中存在责任血管狭窄或闭塞发生率明显较血流灌注正常者高(95.6%vs.11.11%),差异有统计学意义(P<0.05)。发病4.5~9 h内经溶栓治疗患者43例,其中预后良好者28例,预后不良者15例。预后良好者前缺血半暗带rCBV与预后不良比较,差异无统计学意义(P>0.05),预后良好者rCBF较预后不良高,rMTT、rTTP较预后不良低,差异均有统计学意义(P<0.05)。结论 多模式CT可早期发现急性前循环缺血性脑卒中的缺血半暗带、梗死核心异常情况,可用于急性前循环缺血性脑卒中患者的预后判断。

Objective To investigate the assessment of ischemic semidarkness zone,infarct core changes,and prognosis in patients with acute anterior circulation ischemic stroke by multimodal CT.Methods This study was a retrospective analysis,100 patients with suspected acute anterior circulation ischemic stroke who came to Foshan Hospital of Traditional Chinese Medicine from January 2021 to June 2023 were selected and underwent multi-modality CT examination before and after treatment.The results of non-contrast CT(NCCT),CT perfusion imaging(CTP),and CT angiography(CTA) were analyzed,and the values of cerebral blood volume(CBV),cerebral blood flow(CBF),mean time to transit(MTT),and time to peak(TTP) in the ischemic semi-dark band region,infarcted core region of patients with acute anterior circulation ischemic stroke with those of the healthy side before and after treatment were compared,and the values of ischemia and ischemia in patients with acute anterior circulation ischemic stroke with those of the healthy side before and after treatment were compared.Perfusion parameters [relative cerebral blood volume(rCBV),relative cerebral blood flow(rCBF),relative mean transit time(rMTT),and relative time to peak(rTTP)] in ischemic hemidiaphragm in patients with ischemic stroke,comparing perfusion parameters(rCBF,rCBV,rTTP,rMTT) in the infarct core of patients with ischemic stroke in the acute anterior circulation before and after treatment.The correlation between abnormal perfusion of brain tissue and vascular stenosis was analyzed.Forty-three patients with acute anterior circulation ischemic stroke were diagnosed with good prognosis(modified Rankin score≤2,n=28) and poor prognosis(modified Rankin score>2,n=15) based on thrombolytic therapy within 4.5-9.0 hours of onset.The rCBV,rCBF,rMTT,and rTTP values of ischemic penumbra with good and poor prognosis were compared.Results NCCT examination of 100 suspected patients found that 59 patients could see early hypodense lesions,and the remaining 41 patients did not see obvious abnormality,the positive rate of NCCT was 59.00%.CTP examination results found that 9 out of 100 patients had normal perfusion after CTP examination,and the remaining 91 patients had abnormal cerebral perfusion,which was in line with the clinical symptom,and the positive rate of CTP examination was 91.00%.The results of CTA examination found that there were 88 cases with the presence of stenosis or occlusion of the responsible vessel and 12 cases without the presence of stenosis or occlusion of the responsible vessel.There was no statistically significant difference in CBV between the healthy side and the affected side of the ischemic semidarked band area in acute anterior circulation ischemic stroke(P>0.05),the CBF of the affected side was significantly lower than that of the healthy side,and the MTT and TTP of the affected side were significantly higher than that of the healthy side,the differences were statistically significant(P<0.05).CBV and CBF were significantly lower on the affected side than on the healthy side in the infarct core area,and MTT and TTP were significantly higher on the affected side than on the healthy side,the differences were statistically significant(P<0.05).Compared with the infarct core,the ischemic semi-dark zone were significantly higher rCBV and rCBF and rMTT and rTTP values were significantly lower,the differences were statistically significant(P<0.05).Post-treatment rCBV in the anterior ischemic semi-dark band was not statistically significant compared with pre-treatment(P>0.05).rCBF was higher than pre-treatment,and rMTT and rTTP were lower than pre-treatment,the differences were statistically significant(P<0.05).The incidence of the presence of responsible vessel stenosis or occlusion was significantly higher in those with abnormal perfusion than those with normal perfusion(95.6%vs.11.11%),the difference was statistically significant(P<0.05).Forty-three patients were treated with thrombolysis within 4.5-9.0 h of onset,of whom 28 had a good prognosis and 15 had a poor prognosis.There were no statistically significant differences between rCBV in the anterior ischemic semi-dark band and poor prognosis in those with good prognosis(P>0.05),rCBF was higher than that of poor prognosis,and rMTT and rTTP were lower than that of poor prognosis,the differences were statistically significant(P<0.05).Conclusion Multimodal CT can detect ischemic semidarkness and infarct core abnormalities in acute anterior circulation ischemic stroke at an early stage,which is important for the prognosis of patients.