摘要
目的基于CT灌注成像的相关参数灌注显像不匹配(Mismatch)比率及低灌注指数(HIR)用于预测颅内动脉粥样硬化性狭窄(ICAS)相关的急性颅内大血管闭塞。方法选择2019年2月至2020年12月巴音郭楞蒙古自治州人民医院神经内科收治的急性颅内大血管闭塞行急诊取栓患者82例,根据发病机制分为ICAS相关大血管闭塞(ICAS-LVO)组65例和心源性栓塞组17例。使用ROC曲线分析CT灌注成像参数的预测价值。结果与心源性栓塞组比较,ICAS-LVO组男性、体质量指数、三酰甘油、病程进展性加重、发病至手术时间、缺血半暗带、Mismatch比率明显升高,心房颤动、B型钠尿肽、高密度脂蛋白、梗死体积、HIR明显降低,差异有统计学意义(P<0.05,P<0.01)。ROC曲线分析显示,HIR和Mismatch比率对ICAS-LVO病因具有良好的预测价值,其中HIR的最佳截断值为0.26,曲线下面积为0.74,特异性为0.88,敏感性为0.54;Mismatch比率的最佳截断值为3.84,曲线下面积为0.84,特异性为0.75,敏感性为0.90。广义线性模型显示,HIR与脑血容量指数对预后能力无显著差异(P=0.175)。结论HIR及Mismatch比率有助于及早明确发病机制,更准确地制定手术策略,从而更大程度地减少医源性损伤,提高有效开通率,降低致残率和病死率,并改善临床功能预后。
Objective To evaluate the value of perfusion imaging mismatch and low perfusion ratio(HIR)based on CT perfusion imaging in predicting acute intracranial large vessel occlusion(LVO)associated with intracranial atherosclerotic stenosis(ICAS).Methods A total of 82 patients with acute intracranial LVO who underwent emergency thrombectomy in our hospital from February 2019 to December 2020 were enrolled in this study.According to the etiology,they were divided into ICAS-related LVO group(ICAS-LVO,65 cases)and cardiogenic embolism group(17 cases).ROC curve was plotted to analyze the predictive value of CT perfusion imaging parameters.Results Compared with the cardiogenic embolism group,the ICAS-LVO group had significantly larger male ratio,higher BMI and TG level,more severe progression of disease,longer time from onset to surgery,larger proportion of ischemic penumbra and higher mismatch ratio,and obviously less ratio of atrial fibrillation,lower BNP and HDL levels,smaller infarct volume,and lower HIR(P<0.05,P<0.01).ROC curve analysis showed that HIR and mismatch ratio had good predictive value for the etiology of ICAS-LVO.The optimal cut-off value of HIR was 0.26,with an AUC value of 0.74,a specificity of 0.88,and a sensitivity of 0.54.The optimal cutoff for the mismatch ratio was 3.84,with an AUC value of 0.84,a specificity of 0.75,and a sensitivity of 0.90.Generalized linear model revealed that HIR and cerebral blood volume index had no significant difference in prognostic performance(P=0.175).Conclusion HIR and mismatch ratio are helpful to identify the pathogenesis earlier and formulate surgical strategies more accurately,thereby reducing iatrogenic injury to a greater extent,increasing the effective reperfusion rate,reducing the disability and mortality,and improving the prognosis of clinical outcomes.
作者
吴新山
鲁潇慧
于金萍
贾向军
艾克拜尔·加马力
孟根才次克
Wu Xinshan;Lu Xiaohui;Yu Jinping;Jia Xiangjun;Aikebaier·Jiamali;Menggencaicike(Department of Neurology,Bayingoleng Mongolian Autonomous Prefecture People's Hospital,Bayingolin 841000,Inner Mongolia Autonomous Region,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2024年第2期179-183,共5页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
新疆巴音郭楞蒙古自治州人民医院科研项目(BY202006)。
关键词
颅内动脉硬化
脑血管障碍
球囊取栓术
CT灌注成像
低灌注指数
intracranial arteriosclerosis
cerebrovascular disorders
balloon embolectomy
CT perfusion imaging
low perfusion index
