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超急性缺血性脑卒中的最有效治疗方法是溶栓治疗, 目前指导溶栓的CT不匹配模型主要是依据CT灌注参数图, CT灌注参数图可以有效地鉴别梗死核心与半暗带[1-2]。然而急性期脑卒中患者躁动或无意识运动不可避免, 特别是在CT灌注动脉期的头部运动, 会导致CT灌注参数图软件做不出参数图, 或伪影太明显而无法进行判读, 以及无法测量参数绝对值和相对值。本研究旨在分析CT灌注源图像(CT perfusion source images, CTPSI)在获得临床诊断和治疗所需要的影像信息中的价值。
CT灌注源图像在诊断超急性期缺血性脑卒中的应用价值
Diagnostic value of perfusion source images in hyperacute stroke
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摘要:
目的 探讨CT灌注源图像(CTPSI)在超急性期缺血性脑卒中诊断中的临床应用价值。 方法 100例急性缺血性脑卒中(发病时间 < 9 h)的患者行“一站式”CT检查,根据动脉期与静脉期CTPSI Alberta卒中早期CT评分(ASPECTS)的不同将100例患者分为2组:有延迟灌注组和无延迟灌注组。分析基线平扫CT、动脉期及静脉期CTPSI ASPECTS,并与随访影像ASPECTS进行对照。Wilcoxon秩和检验比较动脉期CTPSI与静脉期CTPSI ASPECTS之间的统计学差异;应用多元线性回归分析基线“一站式”CT各个影像学形态ASPECTS与随访影像ASPECTS之间的线性依存关系。 结果 100例患者分为有延迟灌注组42例和无延迟灌注组58例。基线平扫CT、动脉期、静脉期和随访影像的ASPECTS中位数(最小值~最大值)在有延迟灌注组分别为:8.0(6.0~10.0)、7.0(1.0~8.0)、8.0(3.0~10.0)、7.5(0~10.0);在无延迟灌注组分别为:8.0(1.0~10.0)、7.5(1.0~10.0)、8.5(1.0~10.0)、7.0(0~10.0)。在无延迟灌注组,动脉期与静脉期CTPSI ASPECTS差异无统计学意义(Z=-1.00,P=0.459),而在有延迟灌注组,两者差异有统计学意义(Z=-3.08,P= 0.001)。在无延迟灌注组,基线影像ASPECTS(平扫CT、动脉期及静脉期CTPSI)与随访影像ASPECTS均存在正相关(r值分别为0.879、0.902、0.945,P值均 < 0.01);在有延迟灌注组,静脉期CTPSI与随访影像ASPECTS的相关性最好(r=0.831, P=0.004)。多元线性回归结果显示只有静脉期CTPSI与随访影像ASPECTS之间的线性关系有统计学意义:无延迟灌注组,标准化回归系数β= 0.946,P < 0.001;有延迟灌注组,β=0.714,P=0.003。 结论 CTPSI显示无延迟灌注者不存在缺血半暗带,提示不适合溶栓治疗;有延迟灌注者提示存在缺血半暗带,是溶栓治疗的重要依据之一。 -
关键词:
- 脑血管意外 /
- 脑缺血 /
- 体层摄影术, X线计算机 /
- 灌注
Abstract:Objective To investigate the diagnostic value of CT perfusion source images(CTPSI)in acute stroke less than 9 hours. Methods "One-stop shop"CT examination were performed in 100 patients with symptoms of acute stroke in less than 9 hours.Patients were divided into two groups according to with and without delayed perfusion on CTPSI, and compared Alberta stroke program early CT score study(ASPECTS)scores on non-contrast CT, arterial phase CTPSI and venous phase CTPSI with follow-up imaging.The ASPECTS were analyzed on arterial phase CTPSI and venous phase CTPSI using Wilcoxon rank-sum test, then compared with the follow up imaging ASPECTS using multiple linear regressions. Results The median(min-max)scores of ASPECTS on NCCT, arterial phase CTPSI, venous phase CTPSI and follow-up imaging were 8.0(6.0-10.0), 7.0 (1.0-8.0), 8.0(3.0-10.0)and 7.5(0-10.0)in group with delayed perfusion, respectively, and 8.0(1.0-10.0), 7.5 (1.0-10.0), 8.5(1.0-10.0)and 7.0(0-10.0)in group without delayed perfusion respectively.ASPECTS scores measured on arterial phase CTPSI did not differ with venous phase CTPSI group without delayed per-fusion (Z=-1.00, P=0.459), while there was statistic difference in group with delayed perfusion(Z=-3.08, P=0.001).There were significant correlation of ASPECTS scores measured on mon-contrast CT, arterial phase CTPSI and venous phase CTPSI to follow-up imaging ASPECTS(r=0.879, 0.902, 0.945, P < 0.01)in group without delayed perfusion; ASPECTS measured in venous phase CTPSI showed the best correlation to follow-up imaging ASPECTS (r=0.831, P=0.004)in group with delayed perfusion.Multiple linear regression showed that the correlation in only venous phase CTPSI with follow-up imaging ASPECTS was statistically significant: in group without delayed perfusion, β=0.946, P < 0.001; in group with delayed perfusion, β=0.714, P=0.003. Conclusion Presence of delayed perfusion in CTPSI is quit important in identifying ischemic penumbra, which plays a critical role in imaging-guided thrombolytic therapy. -
Key words:
- Cerebrovascular accident /
- Brain ischemia /
- Tomography, X-ray computed /
- Perfusion
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