摘要
目的观察RAPID软件的CT灌注(CTP)参数评估急性缺血性脑卒中(AIS)患者侧支循环的价值。方法回顾性分析94例接受一站式脑卒中CT检查的前循环血管闭塞AIS患者,基于多期相CT血管造影(mCTA)侧支循环评分法评估其侧支循环为良好(mCTA评分≥4分)或不良(mCTA评分≤3分)。以RAPID软件处理CTP数据,获得脑血流峰值时间(Tmax>4 s、>6 s、>8 s、>10 s)对应的低灌注区体积(V_(Tmax>4 s)、V_(Tmax>6 s)、V_(Tmax>8 s)、V_(Tmax>10 s))、梗死核心区体积(V_(CBF<30%))及缺血半暗带体积和低灌注强度比值(HIR);比较侧支循环良好(良好组)与不良患者(不良组)年龄、入院时美国国立卫生研究院卒中量表(NIHSS)评分、血糖等一般资料及CTP参数的差异。应用二元logistic回归分析建立联合回归模型,以mCTA侧支循环评分结果为标准,采用受试者工作特征(ROC)曲线评估CTP参数及联合回归模型评估AIS侧支循环状态的效能,分析CTP参数与mCTA侧支循环评分的相关性。结果良好组51例,不良组43例。良好组年龄、入院时NIHSS评分及CTP参数V_(Tmax>4 s)、V_(Tmax>6 s)、V_(Tmax>8 s)、V_(Tmax>10 s)、V_(CBF<30%)、HIR均小于不良组(P均<0.05),其余各项差异均无统计学意义(P均>0.05)。mCTA侧支循环评分与V_(Tmax>6 s)、V_(Tmax>8 s)、V_(Tmax>10 s)、V_(CBF<30%)及HIR均呈负相关(r=-0.523、-0.615、-0.699、-0.786、-0.730,P均<0.05),与V_(Tmax>4 s)无明显相关性(P>0.05)。以CTP参数V_(Tmax>4 s)、V_(Tmax>6 s)、V_(Tmax>8 s)、V_(Tmax>10 s)、V_(CBF<30%)及HIR评估AIS侧支循环良好的曲线下面积(AUC)分别为0.643、0.756、0.793、0.834、0.892及0.851,联合回归模型[Logit(P)=6.82-0.051×V_(CBF<30%)-4.435×HIR-0.053×年龄]的AUC为0.911。结论以RAPID软件所获CTP参数V_(CBF<30%)及HIR可有效评估AIS患者侧支循环。
Objective To explore the value of CT perfusion(CTP)parameters based on RAPID software for evaluating collateral circulation in acute ischemic stroke(AIS)patients.Methods Data of 94 AIS patients with anterior circulation occlusion who underwent one-stop CT examination for stroke were retrospectively analyzed.The collateral circulations were evaluated based on multi-phase CT angiography(mCTA)collateral circulation scoring,and the patients were divided into good collateral circulation(mCTA score≥4 points,good group)and poor collateral circulation(mCTA score≤3 points,poor group).RAPID software was used to process CTP data and obtain CTP parameters,including hypoperfusion volume(V_(Tmax>4 s),V_(Tmax>6 s),V_(Tmax>8 s),V_(Tmax>10 s))corresponding to cerebral blood flow time to maximum(Tmax)>4 s,>6 s,>8 s and>10 s,the volume of infarct core area(V_(CBF<30%)),the volume of cerebral blood flow mismatch and the ratio of hypoperfusion intensity ratio(HIR).The age,National Institutes of Health stroke scale(NIHSS)score on admission,blood glucose and other general clinical data,as well as CTP results were compared between groups.Binary logistic regression analysis was performed to establish a combined model based on the general data and CTP parameters which being statistically different between groups.Taken mCTA collateral circulation score as the standard,receiver operating characteristic(ROC)curve was used to evaluate the efficacy of CTP parameters and the combined model for evaluating collateral circulations of AIS.The correlations of CTP parameters and mCTA collateral circulation score were analyzed.Results There were 51 cases in good group and 43 cases in poor group.The age,NIHSS score,CTP parameters V_(Tmax>4 s),V_(Tmax>6 s),V_(Tmax>8 s),V_(Tmax>10 s),V_(CBF<30%)and HIR of good group were lower than those in poor group(all P<0.05),while there was no significant difference of the other general data and CTP parameters(all P>0.05).mCTA lateral circulation score were negatively correlated with V_(Tmax>6 s),V_(Tmax>8 s),V_(Tmax>10 s),V_(CBF<30%)and HIR(r=-0.523,-0.615,-0.699,-0.786,-0.730,all P<0.05),but not obvious correlated with V_(Tmax>4 s)(P>0.05).The area under the curve of CTP parameters V_(Tmax>4 s),V_(Tmax>6 s),V_(Tmax>8 s),V_(Tmax>10 s),V_(CBF<30%)and HIR for evaluating collateral circulation of AIS was 0.643,0.756,0.793,0.834,0.892 and 0.851,respectively,of the combined regression model(Logit[P]=6.82-0.051×V_(CBF<30%)-4.435×HIR-0.053×age)was 0.911.Conclusion CTP parameters V_(CBF<30%)and HIR based on RAPID software could be used to effectively evaluate the status of collateral circulation in AIS patients.
作者
宋青泽
尹宏宇
张继
SONG Qingze;YIN Hongyu;ZHANG Ji(Graduate School of Dalian Medical University,Dalian 116044,China;Department of Radiology,Taizhou People's Hospital,Taizhou 225300,China)
出处
《中国介入影像与治疗学》
北大核心
2022年第8期481-486,共6页
Chinese Journal of Interventional Imaging and Therapy
基金
江苏省“333高层次人才培养工程”项目(BRA2020193)。
