CTA和CTP评价AIS患者侧支循环建立及脑灌注的研究

doi:10.7517/issn.1674-0475.211225

摘要/Abstract

摘要： 本研究探讨CT血管成像（CTA）、全脑CT灌注成像（CTP）在评估急性缺血性脑卒中（AIS）患者侧支循环建立及脑灌注情况的价值，并分析CTA、CTP与患者预后的关系。选取139例AIS患者接受256层螺旋CT扫描；根据格拉斯哥预后评分（GOS）将患者分为良好组（95例）和不良组（44例）。以DSA侧支循环检出结果作为诊断金标准，CTA诊断AIS患者颅内动脉侧支循环建立的灵敏度为95.12%、特异度为91.23%；良好组患者的侧支循环程度评分、脑血容量（CBV）、脑血流速度（CBF）、达峰时间（TTP）、平均通过时间（MTT）测定值均高于不良组（P<0.05）；AIS患者入院时NIHSS评分高、梗死灶面积较大、脑血管闭塞是其不良预后的独立危险因素（P<0.05）；良好的侧支循环、CBV及CBF脑灌注水平较高，有利于患者后期的预后恢复（P<0.05）。CTA对AIS患者颅内动脉侧支循环建立的检出敏感度较高，同时，早期观察患者侧支循环建立及脑灌注水平，对评估患者预后恢复具有一定的临床价值。

关键词: 急性缺血性脑卒中, CT血管成像, 全脑CT灌注成像, 侧支循环, 脑灌注, 预后

Abstract: This study investigated the value of CT angiography (CTA) and whole brain CT perfusion imaging (CTP) in assessing the establishment of collateral circulation and cerebral perfusion in patients with acute ischemic stroke (AIS), and analyzed the relationship between CTA, CTP and patient prognosis. 139 patients with AIS were selected for 256-slice spiral CT scan. According to the Glasgow outcome scale (GOS), the patients were divided into a good group with 95 cases and a poor group with 44 cases. Taking the detection results of DSA collateral circulation as the diagnostic gold standard, the sensitivity and specificity of CTA in diagnosing the establishment of intracranial arterial collateral circulation in patients with AIS were 95.12% and 91.23%, respectively. The scores of collateral circulation degree, cerebral blood volume (CBV), cerebral blood flow velocity (CBF), time to peak (TTP) and mean transit time (MTT) in the good group were higher than those in the poor group (P<0.05). Higher NIHSS score, larger infarct size, and cerebral vascular occlusion were independent risk factors of poor prognosis for AIS patients at admission (P<0.05). Good collateral circulation, higher levels of CBV and CBF cerebral perfusion are benefit for the recovery of patients' later prognosis (P<0.05). CTA has a higher sensitivity in detecting the establishment of intracranial arterial collateral circulation in patients with AIS. At the same time, early observation of the establishment of collateral circulation and cerebral perfusion level in patients has certain clinical value for evaluating the prognosis and recovery of patients.

Key words: acute ischemic stroke, CT angiography, whole brain CT perfusion imaging, collateral circulation, cerebral perfusion, prognosis

吴磊, 胡东, 高续, 曹雪花, 刘静. CTA和CTP评价AIS患者侧支循环建立及脑灌注的研究[J]. 影像科学与光化学, 2022, 40(4): 778-783.

WU Lei, HU Dong, GAO Xu, CAO Xuehua, LIU Jing. Study of CTA and CTP in Evaluating the Establishment of Collateral Circulation and Cerebral Perfusion in Patients with AIS[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(4): 778-783.

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