CT灌注成像对急性脑梗死病人预后的评估价值

Prognostic value of CT perfusion imaging in patients with acute cerebral infarction

目的:探讨临床应用CT灌注成像(CTPI)参数与常规内科治疗的急性脑梗死预后的关系。方法:收集发病24 h内确诊急性脑梗死、未做动脉取栓或静脉溶栓并行CTPI检查病人相关资料,并以NIHSS作为临床神经功能缺损的评价指标,在发病时进行评价,选择评分4~25分的病人,采用改良Rankin量表(mRS)在发病90 d时随访,mRS<3为预后良好组,mRS≥3为预后较差组。分别记录并分析2组CTPI各项参数,包括同一病变层面内对称测量病变侧和健侧的平均通过时间(MTT)、达峰时间(TTP)、脑血流量(CBF)、脑血容量(CBV)参数值进行对比分析,判断患侧CTPI参数的改变与病人的预后之间是否存在显著的联系,以及患侧CTPI参数预测脑梗死预后情况是否存在显著差异,进一步确定CTPI参数是否能准确预测脑梗死预后情况。结果:预后不良组患侧CBV和CBF低于健侧,MTT和TTP长于健侧,差异均有统计学意义(P<0.01);预后良好组患侧CBF低于健侧,MTT长于健侧,差异均有统计学意义(P<0.01和P<0.05),CBV和TTP患侧与健侧相比差异无统计学意义(P>0.05);预后不良组患侧CBV和CBF低于预后良好组患侧,MTT和TTP长于预后良好组患侧(P<0.05~P<0.01);而2组间健侧各参数比较差异均无统计学意义(P>0.05)。多因素logistic回归分析提示,CBF参数对预测脑梗死预后更为准确,CBF越高,脑梗死病人预后良好的可能性越大。结论:在CTPI各参数与脑梗死预后密切相关,CBF参数对脑梗死预后预测的价值最大,可以在脑梗死早期便快速地预测脑梗死的预后,可为神经内科临床工作人员在选择治疗方案、判断及改善预后提供重要依据。

Objective:To investigate the relationship between clinical CT perfusion imaging(CTPI)parameters and prognosis of acute cerebral infarction after conventional medical treatment.Methods:The relevant data of patients diagnosed with acute cerebral infarction within 24 hours of onset,who underwent CTPI examination without arterial thrombectomy or intravenous thrombolysis,were collected.The NIHSS was used as an evaluation index of clinical neurological impairment,and the patients were evaluated at the time of onset.Patients with scores 4-25 points were selected.The modified Rankin scale(mRS)was used to follow up at 90 days after the onset of the disease.The patients with mRS<3 and mRS≥3 were divided into the good prognosis group and poor prognosis group,respectively.The CTPI parameters[including the mean transit time(MTT),time to peak(TTP),cerebral blood flow(CBF)and cerebral blood volume(CBV)]in two groups were recorded and analyzed to determine whether there was a significant correlation between the change of CTPI parameters on the affected side and prognosis of the patients,and whether there was a significant difference in the prediction of the prognosis of cerebral infarction by CTPI parameters on the affected side,and further determine whether CTPI parameters could accurately predict the prognosis of cerebral infarction.Results:In the poor prognosis group,the CBV and CBF on the affected side were lower than those on healthy side,while the MTT and TTP were longer than those on healthy side,and the differences were statistically significant(P<0.01).The CBF and MTT on the affected side in the good prognosis group were lower and longer MTT than those on healthy side(P<0.01 and P<0.05).However,there was no statistical significance in the CBV and TTP between the affected side and healthy side(P>0.05).The CBV and CBF of the affected side in the poor prognosis group were lower than those in good prognosis group,while the MTT and TTP were longer than those in good prognosis group(P<0.05 to P<0.01).However,there was no statistical significance in various parameters on the healthy side between two groups(P>0.05).The results of multivariate logistic regression analysis showed that the CBF parameter was more accurate in predicting the prognosis of cerebral infarction.The higher the CBF,the greater the likelihood of a good prognosis for patients with cerebral infarction.Conclusions:The parameters of CTPI are closely related to the prognosis of cerebral infarction,and the CBF parameter has the greatest value in predicting the prognosis of cerebral infarction.It can quickly predict the prognosis of cerebral infarction in the early stage to provide the important basis for clinical staff in neurology to choose treatment plans,judge and improve prognosis.