CT血管造影和数字减影血管造影对软脑膜侧支循环评估对比

目的对比CT血管造影(CTA)与数字减影血管造影(DSA)对软脑膜侧支代偿评估的一致性及其与临床预后的关系。方法选择2015年6月~2019年3月我院收治的一侧大脑中动脉闭塞的患者51例,患者发病1周内同时接受CTA和DSA检查。CTA和DSA血流评分分别由2位医师双盲评估患者侧支血流情况,分为血流良好、一般和不良,以DSA为金标准,判断CTA评估的准确性,应用Kappa检验评估的一致性。3个月时用改良的Rankin量表(mRS)评分评定患者预后,分析2种评分与预后的相关性。结果CTA血流评分判断侧支血流良好9例,一般19例,不良23例,DSA血流评分判断侧支血流良好5例,一般21例,不良25例。2位医师CTA评分具有高度一致性(κ=0.655,95%CI:0.471~0.820,P<0.01);2位医师DSA评分具有高度一致性(κ=0.732,95%CI:0.556~0.891,P<0.01)。CTA评估侧支血流不良的敏感性是80.77%,特异性是72.00%,阳性预测值是75.55%,阴性预测值是78.26%,准确性是76.47%。CTA与DSA评分为中度一致性(κ=0.420,95%CI:0.206~0.621,P<0.01)。CTA血流评分与3个月预后相关(OR=0.19;95%CI:0.04~0.84,P=0.028)。DSA判断侧支不同血流程度患者吸烟比例比较有显著差异(P=0.045)。结论CTA与DSA评估软脑膜侧支循环血流中度一致;CTA血流评分与3个月预后相关;吸烟可能与侧支血流是否良好有关。

Role of CTA and DSA in assessment of meningeal collateral circulation

Objective To compare the consistency of CTA and DSA in assessment of meningeal collateral circulation and its relationship with the clinical outcome of middle cerebral artery occlusion(MCAO).Methods Fifty-one unilateral MCAO patients admitted to our hospital from June 2015 to March 2019 underwent both CTA and DSA within 1 week after onset of MCAO.Their blood flow was assessed as very good,good and poor according to their meningeal collateral circulation score detected by DSA and CTA.The accuracy of CTA in assessment of their meningeal blood flow was calculated with DSA as the gold standard.The consistency of CTA and DSA in assessment of meningeal collateral circulation was assessed by Kappa test.The relationship of CTA and DSA with mRS score was analyzed.Results CTA showed that the meningeal collateral circulation was very good in 9 patients,good in 19 patients and poor in 23 patients respectively while DSA revealed that the meningeal collateral circulation was very good in 5 patients,good in 21 patients and poor in 25 patients respectively.The consistency of CTA and DSA in assessment of meningeal collateral circulation wasκ=0.655 andκ=0.732 respectively(95%CI:0.471-0.820,P<0.01;95%CI:0.556-0.891,P<0.01).The sensitivity,specificity,positive and negative predictive value,and accuracy of CTA for assessing the poor meningeal collateral circulation was 80.77%,72.00%,75.55%,78.26%,and 76.47%respectively.CTA and DSA showed a moderate consistency in meningeal collateral circulation score(κ=0.420,95%CI:0.206-0.621,P<0.01).CTA displayed that the meningeal collateral circulation score was related with the mRS score at month 3 after onset of MCAO(OR=0.19,95%CI:0.04-0.84,P=0.028)and DSA showed that the rate of smoking was significantly different in patients with a different blood flow.Conclusion The consistency of CTA and DSA is good in assessment of meningeal collateral circulation.The meningeal collateral circulation score is related with the mRS score at month 3 after onset of MCAO and smoking is related with the meningeal collateral blood flow.