颅脑CT血管成像检查对急性缺血性脑卒中患者诊断及预后判断的临床价值分析

Value analysis of cranial CT angiography for diagnosis and prognosis of patients with acute ischemic stroke

目的 探讨颅脑CT血管成像检查对急性缺血性脑卒中患者诊断及预后判断的临床价值。方法 回顾性分析66例急性缺血性脑卒中患者的临床资料,患者在发病后24 h内进行颅脑CT平扫、颅脑CT血管成像检查。以数字减影血管造影检查结果为金标准,比较急性缺血性脑卒中患者采用颅脑CT平扫、颅脑CT血管成像检查的检出率、漏诊率,分析颅脑CT血管成像检查对急性缺血性脑卒中患者脑血管狭窄/闭塞、脑血管侧支循环的诊断效能。根据患者出院后90 d的改良Rankin量表评分将患者分为预后不良组和预后良好组,比较预后不良组和预后良好组颅脑CT血管成像检查显示的脑血管狭窄/闭塞、脑血管侧支循环结果。结果 颅脑CT血管成像检查对急性缺血性脑卒中的检出率为93.94%(62/66),明显高于颅脑CT平扫的78.79%(52/66),差异有统计学意义(χ^(2)=6.433,P<0.05)。数字减影血管造影检查显示,66例患者中脑血管无狭窄7例,脑血管狭窄/闭塞59例;颅脑CT血管成像检查显示,66例患者中脑血管无狭窄8例,脑血管狭窄/闭塞58例。以数字减影血管造影检查为金标准,颅脑CT血管成像对急性缺血性脑卒中患者脑血管狭窄/闭塞情况的诊断总符合率为93.94%(62/66)。数字减影血管造影检查显示,66例患者中侧支循环良好30例,侧支循环不良36例;颅脑CT血管成像检查显示,66例患者中侧支循环良好29例,侧支循环不良37例。以数字减影血管造影检查结果为金标准,颅脑CT血管成像诊断急性缺血性脑卒中患者脑血管侧支循环不良的敏感度为88.89%(32/36),特异度为83.33%(25/30),准确度为86.36%(57/66)。根据患者出院后90 d的改良Rankin量表评分将患者分为预后不良组(26例)和预后良好组(40例)。预后良好组患者与预后不良组患者脑血管狭窄/闭塞情况、脑血管侧支循环情况存在明显差异(P<0.05)。结论 颅脑CT血管成像检查在急性缺血性脑卒中诊断方面具有较高诊断效能,能够较好地诊断脑血管狭窄/闭塞、脑血管侧支循环情况,且对患者预后的评判也具有重要临床价值。

Objective To explore the clinical value of cranial CT angiography for diagnosis and prognosis of patients with acute ischemic stroke.Methods The clinical data of 66 patients with acute ischemic stroke were retrospectively analyzed,and the patients underwent cranial CT plain scan and cranial CT angiography within 24 h after onset.Using the results of digital subtraction angiography as the gold standard,the detection rate and missed diagnosis rate of cranial CT plain scan and cranial CT angiography for acute ischemic stroke were compared,and the diagnostic efficiency of cranial CT angiography for cerebrovascular stenosis/occlusion and cerebrovascular collateral circulation in patients with acute ischemic stroke was analyzed.According to the modified Rankin scale score at 90 d after discharge,the patients were divided into the poor prognosis group and the good prognosis group,and the results of cerebrovascular stenosis/occlusion and cerebrovascular collateral circulation by cranial CT angiography were compared between the poor prognosis group and the good prognosis group.Results The detection rate of cranial CT angiography for acute ischemic stroke was 93.94%(62/66),which was significantly higher than 78.79%(52/66) of cranial CT plain scan,and the difference was statistically significant(χ~2=6.433,P<0.05).Digital subtraction angiography showed that 7 of the 66 patients had no cerebrovascular stenosis and 59 cases had cerebrovascular stenosis/occlusion.Cranial CT angiography showed that 8 of the 66 patients had no cerebrovascular stenosis and 58 cases had cerebrovascular stenosis/occlusion.Using digital subtraction angiography as the gold standard,the compliance of cranial CT angiography for cerebrovascular stenosis/occlusion in patients with acute ischemic stroke was 93.94%(62/66).Digital subtraction angiography showed that 30 of 66 patients had good collateral circulation and 36 cases had poor collateral circulation.Cranial CT angiography showed that 29 of the 66 patients had good collateral circulation and 37 cases had poor collateral circulation.Using digital subtraction angiography examination as the gold standard,the sensitivity of cranial CT angiography for poor cerebrovascular collateral circulation in patients with acute ischemic stroke was 88.89%(32/36),the specificity was 83.33%(25/30),and the accuracy was 86.36%(57/66).Patients were categorized into a poor prognosis group(26 patients) and a good prognosis group(40 patients) based on their modified Rankin Scale scores at 90 d after discharge.There were significant differences in cerebrovascular stenosis/occlusion and cerebrovascular collateral circulation between the good prognosis group and the poor prognosis group(P<0.05).Conclusion Cranial CT angiography has high diagnostic efficacy in the diagnosis of acute ischemic stroke,and is able to better diagnose cerebrovascular stenosis/occlusion,cerebrovascular collateral circulation,and also is of great clinical value in the evaluation of patients' prognosis.