【摘要】 目的 探究多期相X线计算机断层扫描(Computed tomography,CT)血管造影(Computed tomography angiography,CTA)+CT灌注成像(Computed tomography perfusion,CTP)一站式扫描在急性脑梗死(Acute ischemic stroke,AIS)侧支循环及缺血半暗带评估中的应用价值。方法 选取2023年1月-2024年12月邯郸市第一医院收治的215例AIS患者,均行多期相CTA全脑灌注成像;比较梗死核心区与缺血半暗带多期相CTA+CTP一站式扫描参数;采用受试者工作特征曲线(Receiver operating characteristic curve,ROC)分析多期相CTA+CTP一站式扫描参数对缺血半暗带的评估价值;比较不同狭窄程度分组多期相CTA+CTP一站式扫描参数;分析多期相CTA+CTP一站式扫描参数与狭窄程度的相关性;比较不同侧支循环状态分组的梗死核心区灌注参数;分析多期相CTA+CTP一站式扫描参数对侧支循环的评估价值。结果 梗死核心区区域软脑膜评分(Regional leptomeningeal collateral score,rLMC)评分、脑血容量(Cerebral blood volume,CBV)、脑血流量(Cerebral blood flow,CBF)均低于缺血半暗带,平均通过时间(Mean transit time,MTT)、达峰时间(Time to peak,TTP)高于缺血半暗带(P<0.05);ROC曲线显示,rLMC评分、MTT,CBV,TTP,CBF联合评估缺血半暗带的曲线下面积(Area under the curve,AUC)为0.905 (95%CI=0.871～0.932)(P<0.05);轻中度狭窄组rLMC评分、CBV,CBF高于重度狭窄组、闭塞组,MTT,TTP低于重度狭窄组、闭塞组(P<0.05);rLMC评分、CBV,CBF与狭窄程度呈负相关(r≤-0.763,P<0.05),MTT,TTP与狭窄程度呈正相关(r≥0.687,P<0.05);侧支循环良好组梗死核心区rLMC评分、CBV,CBF高于侧支循环不良组,MTT,TTP低于侧支循环不良组(P<0.05);ROC曲线显示,rLMC评分、MTT,CBV,TTP,CBF联合评估侧支循环不良的AUC为0.922(95%CI=0.881～0.952)(P<0.05)。结论 多期相CTA+CTP一站式扫描可准确、有效地评估梗死区与缺血半暗带区,可一定程度反映供血动脉狭窄程度及闭塞情况,多期相CTA+CTP一站式扫描参数在AIS侧支循环评估中有重要价值。更多还原

【Abstract】 Objective To explore the application value of multiphasic computed tomography angiography(CTA)+computed tomography perfusion(CTP) one-stop scanning in the assessment of collateral circulation and ischemic penumbra in acute ischemic stroke(AIS).Methods A total of 215 patients with AIS admitted to the Handan first hospital from January 2023 to December 2024 were selected and received multiphasic CTA whole-brain perfusion imaging.The multiphasic CTA+CTP one-stop scan parameters were compared between the infarct core area and the ischemic penumbra,and receiver operating characteristic(ROC) curve was used to analyze the assessment value of multiphasic CTA+CTP one-stop scan parameters for the ischemic penumbra.Multiphasic CTA+CTP one-stop scan parameters were also compared across different stenosis severity groups.The correlation between multi-phase CTA+CTP one-stop scan parameters and stenosis severity was analyzed,and the perfusion parameters of the infarct core area across different collateral circulation status groups were compared to analyze the assessment value of multiphasic CTA+CTP one-stop scan parameters for collateral circulation.Results The regional leptomeningeal collateral(rLMC) score,cerebral blood volume(CBV),and cerebral blood flow(CBF) in the infarcted core area were all lower than those in the ischemic penumbra,while mean transit time(MTT) and time to peak(TTP) were higher than those in the ischemic penumbra(P<0.05).The ROC curve showed that the area under the curve(AUC) of the combined assessment of rLMC score,MTT,CBV,TTP,and CBF for ischemic penumbra was 0.905(95%CI=0.871～0.932)(P<0.05).The rLMC score,CBV,and CBF of the mild to moderate stenosis group were higher than those of the severe stenosis group and occlusion group,while MTT and TTP were lower than those of the severe stenosis group and occlusion group(P<0.05).The rLMC score,CBV,CBF are negatively correlated with the degree of stenosis(r≤-0.763,P<0.05),while MTT and TTP are positively correlated with the degree of stenosis(r≥0.687,P<0.05).The rLMC score,CBV,and CBF in the infarcted core area of the group with good collateral circulation were higher than those in the group with poor collateral circulation,while MTT and TTP were lower than those in the group with poor collateral circulation(P<0.05).The ROC curve showed that the AUC for the combined assessment of collateral circulation dysfunction using rLMC score,MTT,CBV,TTP,and CBF was 0.922(95%CI=0.881～0.952)(P<0.05).Conclusion The multiphasic CTA+CTP one-stop scanning can accurately and effectively assess the infarct area and ischemic penumbra,and can reflect the degree of stenosis and occlusion of the feeding artery to a certain extent.The multiphasic CTA+CTP one-stop scan parameters are of great value in the assessment of collateral circulation in AIS.更多还原