头颅CT灌注成像对急性脑梗死后出血转化预测的价值

目的探讨头颅CT灌注成像(CTP)对急性脑梗死后出血转化的预测效果。方法以前瞻性和回顾性两种模式对43例急性脑梗死患者的两次CTP结果进行分析,以横向组间比较及纵向组内比较筛选出出血组和未出血组的差异性指标,并纳入Logistic回归分析。结果一般资料比较结果显示出血组的年龄、美国国立卫生研究院卒中量表(NIHSS)评分、梗死面积显著高于未出血组(t=-4.604,P=0.000;t=-18.565,P=0.000;t=-9.100,P=0.000)。两次CTP成像参数比较结果显示尽管出血组和未出血组的脑血流量(CBF)均无差异,但其变化的脑血流量差值(ΔCBF)在两组之间呈现显著差异(t=21.182,P=0.000)。进一步的Logsitic回归分析显示ΔCBF是急性脑梗死后出血性转化的危险因素(OR=2.234,95%CI:1.293~3.860)。ROC曲线下面积为0.927,模型预测准确率为87.5%。结论ΔCBF可对急性脑梗死后出血转化进行有效预测,急性脑梗死后的CTP分析中应注意增高的CBF。

Value of CT Perfusion Imaging in Predicting Hemorrhage Transformation After Acute Cerebral Infarction

Objective to investigate the predictive effect of head CT perfusion imaging(CTP)on hemorrhagic transformation after acute cerebral infarction.Methods Two CTP results of 43 patients with acute cerebral infarction were analyzed prospectively and retrospectively.The different indexes between the hemorrhage group and the non-hemorrhage group were screened out by the comparison between the transverse group and the longitudinal group,and were included in the Logistic regression analysis.Results The comparison of general data showed that the age,NIHSS score and infarct area of the bleeding group were significantly higher than those of the non-bleeding group(60.1±4.7 vs.68.2±6.3 years,t=-4.604,P=0.000;8.3±0.7 vs.16.2±1.7 scores,t=-18.565,P=0.000;46.0±5.6 vs.65.8±7.9 mm^2,t=-9.100,P=0.000).Two CTP imaging parameters comparison results show that although bleeding and bleeding group CBF had no difference,the change ofΔCBF show significant differences between the two groups(2.33±0.21 vs.0.97±0.10,t=21.182,P=21.182).Further Logsitic regression analysis showed thatΔCBF is a risk factor for acute hemorrhagic transformation after cerebral infarction(OR=2.234,95%CI:1.293~3.860).The area under the ROC curve was 0.927 while the prediction accuracy of the model was 87.5%.Conclusion CBF can effectively predict the hemorrhagic transformation after acute cerebral infarction.Increased CBF should be examined in CTP imaging analysis after acute cerebral infarction.