【摘要】 目的 探讨计算机断层扫描灌注成像(CTP)低灌注指数比(HIR)与动脉自旋标记灌注成像(ASL)在缺血性脑卒中(CIS)侧支循环中的关系。方法 选取2021年12月—2023年12月呼和浩特市第一医院收治的92例CIS患者为研究对象，常规治疗2周后均行计算机断层血管成像(CTA)、CTP、ASL及数字减影血管造影(DSA)检查，以DSA结果为诊断“金标准”，根据治疗2周后侧支循环评分，将患者分别纳入侧支良好组(55例)、侧支不良组(37例)。比较2组一般资料，比较ASL结果与CTA结果，比较2组CTP参数，受试者工作特征(ROC)曲线分析HIR对侧支不良的诊断价值，获取最佳截断值，ROC分析HIR对CIS患者预后的预测价值。结果 ASL诊断CIS患者侧支不良灵敏度为90.73%、特异度为81.08%、准确度为88.04%、误诊率为18.92%、漏诊率为7.27%；侧支不良组rCBV、rCBF值低于侧支良好组，rMTT、Tmax、HIR值高于侧支良好组，差异有统计学意义(P<0.05);ROC曲线显示，治疗2周后HIR值诊断CIS患者侧支不良的曲线下面积(AUC)为0.825(95%CI:0.732～0.896)，且HIR以最佳截断值为界对侧支不良的诊断灵敏度为94.55%、特异度为86.49%、准确度为91.30%、误诊率为13.51%、漏诊率为5.45%，与ASL诊断结果具有良好一致性(Kappa值：0.930,95%CI:0.895～0.972);rCBV、rCBF值[(0.74±0.13)m L/100 g、(18.88±1.92)mL/min·100 g]低于预后良好患者，差异有统计学意义(P<0.05);Logistic回归分析显示，校正后HIR是CIS患者预后不良的独立相关影响因素，差异有统计学意义(P<0.05)。结论 CTP HIR与ASL诊断CIS患者侧支不良结果具有良好一致性，且HIR对侧支不良及预后不良具有一定诊断及预测价值，可作为临床判断侧支状态、预测预后的辅助参数。更多还原

【Abstract】 Objective To investigate the relationship between low perfusion index ratio(HIR) of computed tomography perfusion imaging(CTP) and arterial spin-labeled perfusion imaging(ASL) in collateral circulation of ischemic stroke(CIS).Methods Ninety-two CIS patients admitted to our hospital from December 2021 to December 2023 were selected as the study objects.Computed tomography angiography(CTA),CTP,ASL and digital subtraction angiography(DSA) we re all examined 2 weeks after routine treatment,and DSA results were taken as the "gold standard" for diagnosis.According to the collate ral circulation sco re after 2 weeks of treatment,the patients we re included in the good collateral group(55 cases) and the poor collateral group(37 cases).General data of the two groups were compared,ASL results were compared with CTA results,and CTP parameters of the two groups were compared.Receiver operating characteristic(ROC) curve was used to analyze the diagnostic value of HIR for collateral malocclusion.Predictive value of HIR in CIS patients by ROC analysis.Results The sensitivity of ASL in the diagnosis of collateral malocclusion in CIS patients was 90.73%,the specificity was 81.08%,the accuracy was 88.04%,the misdiagnosis rate was 18.92%,and the missed diagnosis rate was 7.27%.The rCBV and rCBF values of the poor collateral group were lower than those of the good collateral group.rMTT,Tmax and HIR values were higher than those of good lateral rami group,and the difference was statistically significant(P<0.05).The ROC curve showed that the area under the curve(AUC) of HIR value for diagnosing collateral malocclusion in CIS patients after 2 weeks of treatment was 0.825(95%CI:0.732-0.896),and HIR with the best cut-off value as the boundary of the diagnosis of lateral malocclusion sensitivity was 94.55%,specificity was 86.49%,accu racy was 91.30%,misdiagnosis rate was 13.51%,missed diagnosis rate was 5.45%.There was good consistency with the diagnosis results of ASL(Kappa value:0.930,95%CI:0.895～0.972).The difference was statistically significant(P<0.05).Logistic regression analysis showed that the adjusted HIR was an independent factor associated with poor prognosis in CIS patients,and the difference was statistically significant(P<0.05).ROC curve showed that after 2 weeks of treatment,the HIR value predicted the short-term poor prognosis of CIS patients with AUC 0.794(95%CI:0.697~0.871),the best diagnostic sensitivity was 82.61%,and the specificity was 62.32%.Conclusion There is good consistency between CTP HIR and ASL in the diagnosis of collateral malocclusion in CIS patients,and HIR has certain diagnostic and predictive value in the diagnosis and prognosis of collateral malocclusion and poor prognosis,and ca n be used as an auxiliary para meter in clinical judgment of collateral status and prognosis.更多还原