急性缺血性脑卒中患者溶栓治疗后半暗带CT灌注成像参数的预测价值

目的  研究急性缺血性脑卒中（AIS）患者溶栓治疗后CT灌注成像参数变化及其对预后的早期预测价值。方法  选取2019年3月~2022年3月我院90例AIS患者临床资料为样本开展回顾性研究,均于随访3月时采用改良Rankin量表（mRS）评分并根据结果分组,以mRS≤2分为预后良好组（n=31）,>2分为预后不良组（n=59）,比较两组溶栓治疗后半暗带CT灌注成像参数脑血容量（CBV）、脑血流量（CBF）、平均通过时间（MTT）和达峰时间（TTP）,并以健侧为对照计算各参数相对值rCBF、rCBV、rMTT和rTTP,分析各参数对AIS患者预后的预测价值。结果  溶栓治疗后预后不良组AIS患者半暗带CBF、CBV、rCBF和rCBV均低于预后良好组（P < 0.05）,MTT和TTP均高于预后良好组（P < 0.05）,两组rMTT和rTTP比较未见差异, 无统计学意义（P>0.05）;CBF、CBV、MTT和TTP预测AIS患者预后的曲线下面积（AUC）分别为0.701、0.662和0.698,4项参数联合预测的AUC为0.817,敏感度为93.55%,特异性为64.41%;rCBF和rCBV预测AIS患者预后的AUC分别为0.724和0.798,两项参数联合预测的AUC为0.812,敏感度为96.77%,特异性为57.63%。结论  CT灌注成像可对AIS患者半暗带血流灌注水平进行定量分析,检测溶栓治疗后CBF、CBV、MTT和TTP等参数及其与健侧镜像区脑组织相对值可为早期评估患者预后提供参考。     

CT灌注成像评价家犬急性缺血性脑梗死模型的价值分析

目的 探讨CT灌注成像评价家犬急性缺血性脑梗死模型的价值.方法 12只健康雄性家犬按照随机数字表法分为模型组6只与对照组6只.模型组采用介入技术方法 建立急性缺血性脑梗死模型,对照组不建立模型.造模后1周对家犬进行CT灌注成像评价,测定感兴趣区的脑血流量(CBF)、脑血容量(CBV)、局部灌注达到峰值时间(TTP);并...     

CT灌注成像对急性缺血性脑卒中患者脑组织血流灌注情况、脑侧支血流循环状态及责任血管狭窄的评估价值

目的  探究CT灌注成像(CTPI)对急性缺血性脑卒中患者脑组织血流灌注情况、脑侧支血流循环状态及责任血管狭窄的评估价值。 方法  选取攀枝花市中西医结合医院2021年3月~2022年3月收治的51例急性缺血性脑卒中患者,入院后行CT平扫及CT灌注成像。分析患者不同区域脑血流量(CBF)、脑血容量(CBV)、对比剂平均通过时间(MTT)、对比剂峰值时间(TTP),比较不同侧支血流循环状态CTPI参数情况及责任血管不同狭窄程度。 结果  CTPI显示,46例脑组织血流灌注发生异常,CTPI阳性率为90.20%(46/51)。患者患侧梗死病灶区及缺血半暗带CBF值、CBV值均小于健侧,MTT值、TTP值均长于健侧(P < 0.05)。侧支循环良好者患侧CBF值小于健侧,MTT值及TTP值均长于健侧(P < 0.05),而患侧与健侧CBV值比较差异无统计学意义(P > 0.05);侧支循环不良者患侧CBF值及CBV值均小于健侧,且MTT值及TTP值均长于健侧(P < 0.05)。CTPI提示AIS脑组织血流灌注异常患者责任血管重度狭窄或闭塞发生率高于CTPI提示血流灌注正常患者(P < 0.05)。 结论  CTPI可及时准确反映急性缺血性脑卒中患者梗死病灶区、缺血半暗带血流灌注情况,有助于临床掌握患者侧支循环状态,对责任血管狭窄程度进行客观评估。     

The role of CT perfusion imaging in acute stroke diagnosis: a large single-center experience

The objective of this study was to determine the utility of computed tomography perfusion (CTP) scans in diagnosing acute ischemic stroke (AIS). CTP abnormalities in two contiguous supratentorial levels were correlated with diffusion weighted image (DWI) abnormalities on magnetic resonance imaging (the standard for stroke diagnosis) performed within 1 week in 422 suspected acute ischemic strokes. Of 157 AIS confirmed by DWI, 78 showed CTP abnormalities (sensitivity 49.7%). All of these examinations were performed with a mean of 35 min from the initial emergency department neurological examination. Excluding small non-vascular territory strokes left 77 AIS with a total volume of infarcted tissue of more than 5 cc by DWI. Of these, 71 showed CTP abnormalities (sensitivity 92.2%). Of the 265 patients without AIS, none showed CTP abnormalities (specificity 100%). CTP is a rapid, readily available and effective method of diagnosing AIS in clinical practice, particularly the major intracranial vessel strokes that result in a more devastating outcome.     

基于域对齐的深度学习方法在急性缺血性卒中的CT/MRI影像分割上的应用

目的  基于平扫CT提出一种域对齐方法来显著提高急性缺血性卒中(AIS)的早期快速诊断能力。方法  回顾性分析南方医科大学第三附属医院神经内科和神经外科2020年1月~2022年12月收治的入院后3 d内同时接受平扫头颅CT和MRI/DWI、ADC以及T2-Flair序列扫描的AIS患者,构建了一个由318例AIS病例组成的成对CT/MRI影像数据集,分别对每一组配对的教师-学生影像特征进行归一化;再以8∶2的比例随机分为训练集和验证集。设计一种新的生成性对抗性网络来对齐特征层上的跨模式输入,将细节丰富的MRI图像中的语义知识传递到CT图像中进行AIS分割,开发了一种新的域适应算法（Our DA）。结果  与目前性能表现较优异的医学影像分割模型nnUNet相比,Our DA明显优于nnU-Net,每一层验证集之间的分割精度提升约15%。结论  本研究构建的Our DA模型基于MRI/DWI序列的影像特征并迁移到平扫头颅CT上,对平扫头颅CT上的AIS病灶具有较高的自动分割性能,有助于早期自动识别AIS病灶。     

低分子肝素治疗进展型缺血性脑卒中（脑血栓）的临床研究

目的 研究低分子肝素（速避凝）治疗进展型缺血性脑卒中的疗效及安全性。方法 60例发病时间超过24小时,已不适合溶栓治疗的进展型缺血性脑卒中患,随机分为低分子肝素治疗组和低分子右旋糖酐对照组各30例。两组均于治疗前和治疗后14日作神经功能缺损评分,结合治疗后患的病残程度评定疗效。结果 治疗组总有效率为90．0％,而对照组为66．7％,两组比较有显性差异（P＜0．05）。且治疗组未发现有明显的不良反应。结论 低分子肝素治疗进展型缺血性脑卒中是比较安全、有效的方法。     

急性缺血性卒中血管内治疗技术研究进展

急性缺血性卒中已经成为我国第一大致残、致死性疾病。随着以荷兰血管内治疗急性缺血性卒中多中心随机临床试验为代表的五大试验结果公布,机械取栓已经成为治疗颅内大血管闭塞引起的急性缺血性脑卒中的主要手段,迎来了急性脑梗死机械取栓治疗的新时代。目前机械取栓的主要装置有Merci取栓装置、Penumbra吸栓装置、Solitaire™FR支架、Revive SE支架、Trevo支架和Aperio®支架等,针对血管栓塞部位及血管条件要选择不同类型的取栓装置,同时采用不同的取栓技术,比如ADAPT技术、Solumbra技术、Advance技术、SAVE技术、SWIM技术等,才能提高血管再通率,降低并发症。     

缺血核心体积结合相对灌注率在评估急性脑卒中血管再通及预后中的研究

目的探讨急性脑卒中血管内机械取栓(endovascular thrombectomy,EVT)治疗前缺血核心体积(ischemic core volume,ICV)结合相对灌注率在评估血管再通及预后中的价值.材料与方法回顾性分析在本院就诊的急性缺血性脑卒中患者病例200例,所有患者均于治疗前24 h内行MRI检查.灌注...     

AIS-APS评分在预测急性缺血性卒中相关性肺炎中的应用价值研究

目的 评估AIS-APS评分(acute ischemic stroke-associated pneumonia score)预测急性缺血性卒中7d内发生卒中相关性肺炎(stroke-associated pneumonia,SAP)风险的应用价值.方法 采用前瞻性、连续性队列研究的方法,应用AIS-APS评分法对2013年7月至2015年4月北京同仁医院入选的309例急性缺血性卒中患者进行评分,根据患者7d内SAP的发生率,分析AIS-APS评分法预测急性缺血性卒中发生SAP的作用.并检测量表的信度和结构效度.结果 总计有12.9％(40例)急性缺血性卒中患者罹患肺炎.依据AIS-APS评分法:极高危组28～ 35分、高危组21 ～ 27分、中度危险组14～20分、低危险组7～13分和极低危险组0～6分的患者7d内发生SAP的比率分别是90.8％、66.5％、23.5％、8.32％、3.85％.量表和各维度的Cronbach's α系数均大于0.7.结构效度检测结果与量表理想的结构相一致.结论 AIS-APS评分法是一种操作性强的,能对卒中者SAP罹患风险进行分层评价的工具,对急性缺血性卒中相关性肺炎的预测具有较好的信度、效度.利用AIS-APS评分法有助于临床工作中快速筛选出SAP高危患者,对SAP患者可予及早诊断和早期干预.     

Modern imaging of the infarct core and the ischemic penumbra in acute stroke patients: CT versus MRI

Thrombolysis has become an approved therapy for acute stroke. However, many stroke patients do not benefit from such treatment, since the presently used criteria are very restrictive, notably with respect to the accepted time window. Even so, a significant rate of intracranial hemorrhage still occurs. Conventional cerebral computed tomography (CT) without contrast has been proposed as a selection tool for acute stroke patients. However, more-modern MRI and CT techniques, referred to as diffusion- and perfusion-weighted imaging and perfusion-CT, have been introduced, which afford a comprehensive noninvasive survey of acute stroke patients as soon as their emergency admission, with accurate demonstration of the site of arterial occlusion and its hemodynamic and pathophysiological repercussions for the brain parenchyma. The objective of this article is to present the advantages and drawbacks of CT and MRI in the evaluation of acute stroke patients.     

Tenecteplase utility in acute ischemic stroke patients: A clinical review of current evidence

Introduction

Acute ischemic stroke is a leading cause of disability in the United States. Treatment is aimed at reducing impact of cerebral clot burden and life-long disability. Traditional fibrinolytic treatment with recombinant tissue plasminogen activator (tPA) has shown to be effective but at high risk of major bleeding. Multiple studies have evaluated tenecteplase as an alternative to tPA.

Predicting treatment-specific lesion outcomes in acute ischemic stroke from 4D CT perfusion imaging using spatio-temporal convolutional neural networks

For the diagnosis and precise treatment of acute ischemic stroke, predicting the final location and volume of lesions is of great clinical interest. Current deep learning-based prediction methods mainly use perfusion parameter maps, which can be calculated from spatio-temporal (4D) CT perfusion (CTP) imaging data, to estimate the tissue outcome of an acute ischemic stroke. However, this calculation relies on a deconvolution operation, an ill-posed problem requiring strong regularization and definition of an arterial input function. Thus, improved predictions might be achievable if the deep learning models were applied directly to acute 4D CTP data rather than perfusion maps. In this work, a novel deep spatio-temporal convolutional neural network is proposed for predicting treatment-dependent stroke lesion outcomes by making full use of raw 4D CTP data. By merging a U-Net-like architecture with temporal convolutional networks, we efficiently process the spatio-temporal information available in CTP datasets to make a tissue outcome prediction. The proposed method was evaluated on 147 patients using a 10-fold cross validation, which demonstrated that the proposed 3D+time model (mean Dice=0.45) significantly outperforms both a 2D+time variant of our approach (mean Dice=0.43) and a state-of-the-art method that uses perfusion maps (mean Dice=0.38). These results show that 4D CTP datasets include more predictive information than perfusion parameter maps, and that the proposed method is an efficient approach to make use of this complex data.     

多时相CT血管造影对急性缺血性脑卒中患者侧支循环评估价值及溶栓治疗指导作用

目的 探讨多时相CT血管造影(CTA)对急性缺血性脑卒中(AIS)患者侧支循环评估价值及溶栓治疗指导作用.方法 我院收治的AIS患者,选取其中接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的120例患者为研究对象.治疗前均给予多时相CTA检查,根据影像学检查结果及Alberta卒中项目早期CT评分(ASPECT...     

解读AAN发布的《DWI和PWI在缺血性卒中的诊断价值-循证指南》

近期,美国神经病学学会（AAN）治疗与技术评定小组发布了《磁共振扩散加权成像（DWI）和灌注加权成像（PWI）在缺血性卒中的诊断价值一循证指南》（以下简称《指南》）,《指南》以循证医学证据为基础,对相关研究试验进行回顾分析,并得出具有指导意义的6条推荐意见。本文对《指南》的主要内容进行介绍,对其采用的相关循证医学依据进行解读。     

头颅CTA造影联合磁共振血管成像诊断急性缺血性脑卒中的价值

目的 探究头颅CT血管造影(CTA)联合磁共振血管成像(MRA)在诊断急性缺血性脑卒中(AIS)中的应用价值.方法 回顾性选取2018年1月至2020年1月资阳市第一人民医院收治的57例疑似AIS患者,最终确诊42例,收集患者临床资料,所有患者均行数字减影血管造影(DSA)检查及头颅CTA、三维时间飞跃法磁共振血管成像...     

头颈部CT血管造影对急性缺血性脑卒中早期的诊断价值

目的:分析应用头颈部非创伤性血管成像技术(简称CT血管造影)(CT angiography,CTA)实施颈动脉狭窄诊断对于急性缺血性脑卒早期诊断的应用价值.方法:选取2020年5月—2021年5月宁津县人民医院收治的50例疑似颈动脉狭窄急性缺血性脑卒中患者,对入组患者均实施头颈部CTA扫描及颈部血管彩超,对比数字减影血...     

不同中医征候急性缺血性脑卒中患者的心理状况分析

目的 探讨不同中医征候急性缺血性脑卒中患者的心理问题,以指导临床护理人员进行相应的心理干预.方法 应用症状自评量表（SCL-90）对154例急性缺血性脑卒中住院患者进行心理调查,根据中医症候诊断进行相关分析.结果 急性缺血性脑卒中患者存在明显的心理问题;不同中医征候患者心理问题表现不同,＂实证＂和＂虚证＂患者在躯体化、强迫症状、抑郁、敌对方面的表现差异有统计学意义（P＜0.01或P＜0.05）.结论 急性缺血性脑卒中患者存在明显的心理问题,征候虚实不同,临床表现各异,临床护理人员应重视对急性缺血性脑卒中患者的心理护理,并针对不同的证型给予相应的心理干预,以减轻患者的心理问题,改善预后.     

Expedited computed tomography perfusion and angiography in acute ischemic stroke: a feasibility study

Background

Acute ischemic stroke diagnosis and treatment are among the most challenging in Emergency Medicine. Perfusion computed tomography (CTP) can increase the sensitivity for detecting ischemic stroke and, especially with the addition of CT angiography (CTA), improve decision-making regarding thrombolytic therapy compared to non-contrast computed tomography (NCCT) alone. However, because acute stroke protocols do not generally include procedures for multimodal imaging, they are not commonly performed. In addition, there is concern that additional studies could delay or preclude therapy in patients otherwise eligible for thrombolytic therapy.

Objectives

To demonstrate the feasibility of perfusion CTP and CTA in addition to NCCT of the brain in the emergency assessment of patients with acute ischemic stroke. Methods: Starting January 2008, multimodal (CTP and CTA) imaging was added to NCCT in the Emergency Department (ED) initial assessment of patients with stroke of ≤ 5 h duration. Over the subsequent 9 months, we measured the time from ED arrival to imaging and to recombinant tissue plasminogen activator (rt-PA) treatment and compared these times to patients evaluated with CT alone.

Results

From January to October 2008, 95 patients had CTP and CTA studies in addition to NCCT for acute ischemic stroke. There were no differences between the average time to CT study or to rt-PA treatment between patients evaluated with multimodal CT imaging and patients assessed with NCCT alone.

Conclusions

Combining CTP and CTA with NCCT is feasible and does not adversely increase the time to CT imaging or rt-PA treatment in patients with acute ischemic stroke.     

代谢综合征与急性脑梗死患者预后的关系

目的探讨代谢综合征与急性脑梗死患者预后之间的关系。方法观察自2008年1月至2014年1月691例急性脑梗死患者,按照1995年全国第4届脑血管病学术会议《临床疗效评定标准》进行预后评定,运用多因素回归分析评估代谢综合征与急性脑梗死患者预后之间的关系。结果 691例患者中,277例患者预后较差,代谢综合征与急性脑梗死预后之间联系显著,校正OR值(95%CI)为1.57(1.13~2.19),不良预后与代谢综合征包含的危险因素数量之间关系显著。结论代谢综合征与急性脑梗死不良预后关系显著。