取栓前后脑CT灌注参数变化值联合检测对急性缺血性脑卒中患者取栓后复发的预测效能

Predictive efficacy of CT perfusion imaging parameters before and after thrombectomy for recurrence of acute ischemic stroke

目的探讨取栓前后脑CT灌注成像(CTP)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)变化值(ΔrCBV、ΔrCBF、ΔrMTT)联合检测对急性缺血性脑卒中(AIS)患者取栓后复发的预测效能。方法选取2021年6月至2023年6月河南中医药大学第三附属医院收治且行机械取栓术治疗的122例AIS患者作为研究对象。取栓术后随访6个月,根据是否复发分为复发组21例和未复发组101例。比较两组患者取栓前后的rCBV、rCBF、rMTT及ΔrCBV、ΔrCBF、ΔrMTT;采用Spearman相关性分析取栓前后ΔrCBV、ΔrCBF、ΔrMTT与AIS患者取栓后复发的相关性;采用受试者工作特征(ROC)曲线分析取栓前后ΔrCBV、ΔrCBF、ΔrMTT联合检测对AIS患者取栓后复发的预测效能。结果取栓前,复发组患者的rCBV、rCBF分别为(1.08±0.13)m L/100 g、(28.62±2.72)m L/(min·100 g),明显低于未复发组的(1.23±0.18)mL/100 g、(31.57±3.16)m L/(min·100 g),rMTT为(1.40±0.08)s,明显高于未复发组的(1.32±0.10)s,差异均有统计学意义(P<0.05);取栓后,复发组患者的r CBV、rCBF分别为(1.26±0.20)m L/100 g、(32.82±4.07)m L/(min·100 g),明显低于未复发组的(1.51±0.26)m L/100 g、(38.66±5.23)m L/(min·100 g);rMTT为(1.33±0.06)s,明显高于未复发组的(1.20±0.09)s,差异均有统计学意义(P<0.05);且两组患者取栓后的rCBV、r CBF均高于取栓前,r MTT均低于取栓前,差异均有统计学意义(P<0.05);复发组患者取栓前后ΔrCBV、Δr CBF、Δr MTT分别为(0.18±0.06)m L/100 g、(4.20±1.37)m L/(min·100 g)、(0.07±0.02)s,明显低于未复发组的(0.28±0.09)m L/100 g、(7.09±2.32)m L/(min·100 g)、(0.12±0.04)s,差异均有统计学意义(P<0.05);Spearman相关性分析结果显示,取栓前后ΔrCBV、ΔrCBF、ΔrMTT与AIS患者取栓后复发均呈负相关(r=-0.512、-0.617、-0.584,P<0.001);ROC曲线分析结果显示,CTP参数取栓前后变化值ΔrCBV、ΔrCBF、ΔrMTT联合检测预测AIS患者取栓后复发的曲线下面积(AUC)为0.916,明显高于ΔrCBV、ΔrCBF、ΔrMTT单独检测的0.762、0.832、0.810。结论CTP参数取栓前后变化值ΔrCBV、ΔrCBF、ΔrMTT与AIS复发密切相关,其联合检测对AIS复发具有较高的诊断效能,可为临床早期预测AIS取栓后复发提供参考。

Objective To investigate the predictive efficacy of cerebral CT perfusion imaging(CTP)parame-ters(relative cerebral blood volume,rCBV;relative cerebral blood flow,rCBF;and relative mean transit time,rMTT)changes(ΔrCBV,ΔrCBF,ΔrMTT)in combination before and after thrombectomy for recurrence of acute ischemic stroke(AIS).Methods A total of 122 AIS patients who underwent mechanical thrombectomy admitted to the Third Af-filiated Hospital of Henan University of Traditional Chinese Medicine from June 2021 to June 2023 were selected as re-search subjects.The patients were followed up for 6 months after thrombectomy,and they were divided into relapsed group(21 cases)and non-relapsed group(101 cases)according to whether they had relapsed or not.The rCBV,rCBF,rMTT andΔrCBV,ΔrCBF,ΔrMTT before and after thrombectomy were compared between the two group;the correla-tion ofΔrCBV,ΔrCBF,ΔrMTT before and after thrombectomy with the recurrence of AIS patients was analyzed by Spearman correlation analysis;the predictive efficacy of combined detection ofΔrCBV,ΔrCBF andΔrMTT for the re-currence of AIS after thrombectomy was analyzed by receiver operating characteristic(ROC)curve.Results Before thrombectomy,rCBV and rCBF in the relapsed group were(1.08±0.13)mL/100 g and(28.62±2.72)mL/(min·100 g),re-spectively,which were significantly lower than(1.23±0.18)mL/100 g and(31.57±3.16)mL/(min·100 g)in the non-re-lapsed group;rMTT was(1.40±0.08)s,which was significantly higher than(1.32±0.10)s in the non-relapsed group;the differ-ences were statistically significant(P<0.05).After thrombolectomy,the rCBV and rCBF in the relapsed group were(1.26±0.20)mL/100 g and(32.82±4.07)mL/(min·100 g),respectively,which were significantly lower than(1.51±0.26)mL/100 g and(38.66±5.23)mL/(min·100 g)in the non-relapsed group;rMTT was(1.33±0.06)s,which was significantly higher than(1.20±0.09)s in the non-relapsed group;the differences were statistically significant(P<0.05).rCBV and rCBF af-ter thrombectomy were significantly higher than those before thrombectomy,and rMTT was significantly lower than that before thrombectomy in both groups,with statistically significant differences(P<0.05).TheΔrCBV,ΔrCBF,andΔrMTT before and after thrombolectomy in the relapsed group were(0.18±0.06)mL/100 g,(4.20±1.37)mL/(min·100 g),and(0.07±0.02)s,respectively,which were significantly lower than(0.28±0.09)mL/100 g,(7.09±2.32)mL/(min·100 g),(0.12±0.04)s in the non-relapsed group(P<0.05).Spearman correlation analysis showed thatΔrCBV,ΔrCBF,ΔrMTT of CTP parameters before and after thrombectomy were negatively correlated with the recurrence of AIS after thrombectomy(r=-0.512,-0.617,-0.584,P<0.001).ROC curve analysis results showed the area under curve(AUC)ofΔrCBV,ΔrCBF andΔrMTT in combination for predicting recurrence of AIS patients after thrombectomy was 0.916,which was significant-ly higher than 0.762,0.832,and 0.810 ofΔrCBV,ΔrCBF andΔrMTT alone.Conclusion Changes of CTP parameters(ΔrCBV,ΔrCBF,ΔrMTT)before and after thrombectomy are closely related to the recurrence of AIS,and their com-bined detection has high diagnostic efficiency for AIS recurrence,which can provide reference for early clinical predic-tion of recurrence of AIS after thrombectomy.