基于CT灌注扫描彩色血流图预测经血管内治疗急性缺血性卒中患者术后脑水肿程度的价值

The value of flow visualization map based on CT perfusion in predicting the degree of cerebral edema after endovascular treatment of acute ischemic stroke

目的:探讨基于CT灌注扫描彩色血流图在预测经血管内治疗前循环狭窄所致缺血性卒中脑水肿程度的价值,并建立诺谟图风险模型评估中重度脑水肿风险。方法:回顾性分析本院63例经血管内治疗(术后mTICI分级≥2b级)的前循环狭窄所致急性缺血性卒中患者,所有患者行颅脑CT灌注(CTP)扫描,基于CTP扫描源数据重建彩色血流图(FVM)并进行评分。基于DSA检查行ASITN/SIR侧支循环评估。基于复查CT患者脑肿胀程度进行评分(0~3分),将0~1分定义为轻度水肿组;2~3分定义为中重度水肿组。统计两组间在心血管危险因素、NIHSS评分、ASPECT评分、FVM评分、核心梗死区体积、低灌注区体积、缺血半暗带体积之间的差异,二元logistic回归用于分析中重度脑水肿发生的危险因素,并构建诺谟图(Nomogram)风险模型,建立受试者工作特征曲线及校准曲线验证其效能。结果:轻度水肿组44人,中重度水肿组19人。单因素分析显示轻度水肿组年龄、核心梗死区体积小于中重度水肿组(P>0.05);FVM评分高于中重度水肿组(P>0.05)。二元logistics分析显示核心梗死区体积(OR=1.038,95%CI=1.006~1.072,P=0.021)、FVM评分(OR=0.268,95%CI=0.116~0.623,P=0.002)是中重度水肿的独立预测因素。基于独立预测因素构建的诺谟图模型曲线下面积为0.893(95%CI=0.817~0.969,P<0.01)。校准曲线及Hosmer-Lemeshow检验显示该模型预测符合度(P=0.723)良好。结论:低FVM评分、高核心梗死区体积是经血管内治疗急性前循环闭塞AIS患者发生中重度脑水肿的独立危险因素,基于两者构建的Nomogram模型可以有效评估中重度脑水肿风险。

Objective:To explore the value of predicting the degree of cerebral edema in ischemic stroke caused by endovascular treatment of anterior circulation occlusion using the flow visualization map(FVM)of CT perfusion(CTP)and to construct a nomogram risk assessment system.Methods:A retrospective analysis was conducted on 63 patients with acute ischemic stroke due to anterior circulation occlusion who underwent endovascular treatment(postoperative mTICI grade≥2b)at our hospital.All patients underwent CTP scanning.The scan source data was transferred to the flow visualization soft ware to reconstruct the FVM and score it.The ASITN/SIR collateral circulation was assessed based on DSA examination.The degree of cerebral edema was scored(0~3 points)based on re-examination CT,with 0~1 points defined as the mild edema group and 2~3 points defined as the moderate to severe edema group.Differences between the two groups in cardiovascular risk factors,admission NIHSS score,ASPECT score,FVM score,core infarction area volume,hypoperfusion area volume,and ischemic penumbra volume were statistically analyzed.Binary logistic regression was used to identify risk factors for moderate to severe cerebral edema and to construct a nomogram risk model.Receiver operating characteristic(ROC)curves and calibration curves were established to verify the model's effectiveness.Results:There were 44 patients in the mild edema group and 19 patients in the moderate to severe edema group.Univariate analysis showed that the age and core infarction area volume of the mild edema group were smaller than those of the moderate to severe edema group(P<0.05).The FVM score was higher in the mild edema group compared to the moderate to severe edema group(P<0.05).Binary logistic analysis indicated that core infarct volume(OR=1.038,95%CI=1.006~1.072,P=0.021)and FVM score(OR=0.268,95%CI=0.116~0.623,P=0.002)were independent predictors of moderate to severe edema.Conclusion:The study demonstrates that core infarct volume and FVM score are independent predictors of moderate to severe cerebral edema in patients with ischemic stroke due to anterior circulation occlusion treated with endovascular therapy.The nomogram risk model based on these predictors can effectively assess the risk of developing moderate to severe cerebral edema,aiding in clinical decision-making and patient management.