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| 基于CT灌注成像的pc-ASPECTS对椎基底动脉闭塞急性缺血性脑卒中预后的预测价值 |
| 沈红健1△,沈芳1△,尹伟2,邢鹏飞1,李子付1,张磊1,李强1,杨鹏飞1,张永巍1*,刘建民1 |
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(1. 海军军医大学(第二军医大学)长海医院脑血管病中心, 上海 200433;
2. 海军军医大学(第二军医大学)长海医院放射诊断科, 上海 200433
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 探讨基于脑计算机断层扫描灌注成像（CTP）的后循环Alberta脑卒中计划早期计算机断层扫描评分（pc-ASPECTS）对椎基底动脉闭塞急性缺血性脑卒中（VBAO-AIS）预后的预测价值。方法 回顾性分析2019年1月至2020年12月在海军军医大学（第二军医大学）长海医院脑血管病中心接受血管内治疗的56例VBAO-AIS患者资料。所有患者急诊行多模态CT检查评估，获得基于非增强计算机断层扫描（NCCT）、CTP和RAPID-CTP的pc-ASPECTS。以治疗后3个月改良Rankin量表（mRS）评分作为预后评价指标（mRS评分≤3分为预后良好）。采用ROC曲线和多因素logistic回归分析评价基于NCCT与CTP、RAPID-CTP各参数的pc-ASPECTS对预后的预测价值。结果 56例患者中预后良好组29例、预后不良组27例。预后良好组基于NCCT及CTP和RAPID-CTP各参数的pc-ASPECTS均高于预后不良组（P均<0.05）。基于CTP脑血容量（CBV）的pc-ASPECTS和基于RAPID-CBV的pc-ASPECTS预测预后的灵敏度分别为89.7%和79.3%，特异度分别为74.1%和81.5%，AUC值分别为0.861（95%CI 0.760~0.963）和0.861（95%CI 0.764~0.958）。二分类多因素logistic回归分析显示，基于NCCT的pc-ASPECTS≥8分、基于CTP CBV的pc-ASPECTS≥7分、基于CTP平均通过时间（MTT）的pc-ASPECTS≥5分、基于RAPID-CBV的pc-ASPECTS≥8分、基于RAPID-脑血流量（CBF）的pc-ASPECTS≥7分是预测VBAO-AIS患者血管内治疗后3个月预后良好的独立因素（P均<0.05）。结论 基于CTP各参数的pc-ASPECTS是VBAO-AIS患者一个有用的预后指标，尤其是基于CBV的pc-ASPECTS对血管内治疗后3个月预后有较高的预测价值。 |
| 关键词: 急性缺血性脑卒中 椎基底动脉闭塞 计算机断层扫描灌注成像 后循环 Alberta脑卒中计划早期计算机断层扫描评分 血管内治疗 |
| DOI：10.16781/j.0258-879x.2022.01.0042 |
| 投稿时间：2021-09-21 |
| 基金项目:国家自然科学基金（82071278），上海市临床重点专科项目（shslczdzk06101） |
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| Prognostic value of pc-ASPECTS based on CT perfusion in patients with acute ischemic stroke caused by vertebral and basilar artery occlusion |
| SHEN Hong-jian1△,SHEN Fang1△,YIN Wei2,XING Peng-fei1,LI Zi-fu1,ZHANG Lei1,LI Qiang1,YANG Peng-fei1,ZHANG Yong-wei1*,LIU Jian-min1 |
(1. Neurovascular Center, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China;
2. Department of Radiology, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To explore the predictive value of posterior circulation-Alberta Stroke Program early computed tomography score(pc-ASPECTS) based on cerebral computed tomography perfusion(CTP) for prognosis of patients with acute ischemic stroke caused by vertebral and basilar artery occlusion(VBAO-AIS).Methods The data of 56 patients with VBAO-AIS who received endovascular treatment in the Neurovascular Center, Changhai Hospital, Naval Medical University(Second Military Medical University) from Jan. 2019 to Dec. 2020 were retrospectively analyzed. All patients underwent emergency multimodal computed tomography(CT) examination, and the pc-ASPECTSs based on non-contrast computed tomography(NCCT), CTP and RAPID-CTP were obtained. The modified Rankin scale(mRS) score 3 months after treatment was used to evaluate prognosis(mRS score ≤ 3 indicated good prognosis). Receiver operating characteristic(ROC) curve and multivariate logistic regression analysis were used to evaluate the prognostic value of pc-ASPECTS based on NCCT and each parameter of CTP and RAPID-CTP.Results Among the 56 patients, 29 had good prognosis and 27 had poor prognosis. The pc-ASPECTSs based on NCCT and each parameter of CTP and RAPID-CTP were significantly higher in the good prognosis group than those in the poor prognosis group(all P<0.05). The sensitivities of CTP cerebral blood volume(CBV) pc-ASPECTS and RAPID-CBV pc-ASPECTS in predicting prognosis were 89.7% and 79.3%, the specificities were 74.1% and 81.5%, and the area under curve values were 0.861(95% confidence interval[CI]0.760-0.963) and 0.861(95% CI 0.764-0.958), respectively. Binary multivariate logistic regression analysis showed that NCCT pc-ASPECTS ≥ 8, CTP CBV pc-ASPECTS ≥ 7, CTP mean transit time(MTT) pc-ASPECTS ≥ 5, RAPID-CBV pc-ASPECTS ≥ 8, and RAPID-cerebral blood flow(CBF) pc-ASPECTS ≥ 7 were independent factors in predicting good prognosis of VBAO-AIS patients 3 months after endovascular treatment(all P<0.05).Conclusion pc-ASPECTS based on each parameter of CTP is a useful prognostic marker of VBAO-AIS patients. In particular, CBV pc-ASPECTS has a high predictive value for the prognosis of VBAO-AIS patients 3 months after endovascular treatment. |
| Key words: acute ischemic stroke vertebral and basilar artery occlusion computed tomography perfusion posterior circulation Alberta Stroke Program early computed tomography score endovascular treatment |
