基于CT灌注成像评估侧支循环在急性缺血性脑卒中取栓前后脑梗死进展及预后评估中的应用

目的探讨基于CT灌注成像(CTP)评估的侧支循环对急性前循环大动脉闭塞患者取栓前后脑梗死进展及临床预后的影响。方法回顾性分析浙江省人民医院神经内科自2018年5月至2019年9月收治的110例发病24 h以内的急性前循大动脉闭塞患者的资料。所有患者均完成取栓手术,采用区域性软脑膜侧支(rLMC)评分对四维CT血管造影(4D-CTA)上的全时相融合像(tMIP)进行侧支循环评估;根据CTP的核心脑梗死体积和术后1周内头颅MR的DWI影像结果,计算进展梗死体积;采用改良Rankin量表(mRS)评分评估患者术后3个月时预后情况。结果(1)侧支循环好组患者56例,侧支循环差组患者54例。年龄(OR=0.951,95%CI:0.910~0.993,P=0.023)、心功能不全(OR=0.116,95%CI:0.018~0.731,P=0.022)、基线空腹血糖(OR=0.788,95%CI:0.646~0.961,P=0.019)、觉醒性卒中(OR=0.093,95%CI:0.023~0.380,P=0.001)及颈内动脉段闭塞(OR=7.604,95%CI:2.650~21.821,P=0.000)是侧支循环的独立影响因素。(2)侧支循环评分(95%CI:-2.947~-1.474,P=0.000)、缺血半暗带体积(95%CI:0.065~0.126,P=0.000)、脑组织水肿评分(95%CI:2.952~7.600,P=0.000)、出血转化(95%CI:8.966~23.114,P=0.000)及24 h美国国立卫生研究院卒中量表(NIHSS)评分(95%CI:0.606~1.248,P=0.000)是进展梗死体积的独立影响因素。(3)预后良好组患者共59例,预后不良组患者共51例。出血转化(OR=0.019,95%CI:0.001~0.275,P=0.004)及进展梗死体积(OR=0.824,95%CI:0.756~0.897,P=0.000)是急性前循环大动脉闭塞取栓患者远期预后的独立影响因素。结论基于4D-CTA的rLMC侧支循环评分对发病24 h内急性前循环大动脉闭塞取栓患者的进展梗死体积有良好的预测作用,并可通过进展梗死体积进一步预测患者预后。

Influence of collateral circulation evaluated by CT perfusion imaging in infarction progression and prognoses of patients with acute ischemic stroke before and after thrombectomy

Objective To investigate the influence of collateral circulation evaluated by CT perfusion(CTP)imaging in infarction progression and clinical prognoses of patients with acute large-artery occlusion of the anterior circulation before and after thrombectomy.Methods One hundred and ten patients with acute large-artery occlusion of the anterior circulation within 24 h of onset,admitted to our hospital from May 2018 to September 2019,were chosen in our study;all patients completed thrombectomy;their clinical data were analyzed retrospectively.Regional leptomeningeal collateral-temporally fused maximum intensity projection(rLMC-tMIP)was used to evaluate the collateral circulation based on 4D-CT angiography(4D-CTA).According to the core infarct volume in CTP imaging and the diffusion weighted imaging(DWI)results of MR within one week of surgery,the progressive infarct volume was calculated.Modified Rankin scale(mRS)was used to evaluate the prognoses of these patients 3 months after surgery.Results(1)There were 56 patients with good collateral circulation and 54 patients with poor collateral circulation.Age(OR=0.951,95%CI:0.910-0.993,P=0.023),cardiac dysfunction(OR=0.116,95%CI:0.018-0.731,P=0.022),baseline fasting blood glucose(OR=0.788,95%CI:0.646-0.961,P=0.019),wakefulness stroke(OR=0.093,95%CI:0.023-0.380,P=0.001),and site of vascular occlusion(OR=7.604,95%CI:2.650-21.821,P=0.000)were independent influencing factors for collateral circulation.(2)Scores of rLMC-tMIP(95%CI:-2.947--1.474,P=0.000),volume of ischemic penumbra(95%CI:0.065-0.126,P=0.000),scores of edema in the brain tissues(95%CI:2.952-7.600,P=0.000),hemorrhage transformation(95%CI:8.966-23.114,P=0.000),and 24 h NIHSS scores(95%CI:0.606-1.248,P=0.000)were independent influencing factors for volume of progressive infarction.(3)There were 59 patients having good prognosis and 51 patients having poor prognosis.Hemorrhage transformation(OR=0.019,95%CI:0.001-0.275,P=0.004)and progressive infarction volume(OR=0.824,95%CI:0.756-0.897,P=0.000)were independent influencing factors for prognoses of patients with acute large-artery occlusion of the anterior circulation after thrombectomy.Conclusion The scores of rLMC-tMIP based on 4D-CTA can well predict the infarction volume in patients with acute large-artery occlusion of the anterior circulation within 24 h of onset,which can effctively evaluate the clinical prognoses of the patients.