颅脑CT血管成像对急性缺血性脑卒中患者诊断及预后判断的价值

目的探究颅脑CT血管成像(CTA)对急性缺血性脑卒中患者诊断及预后判断的价值。方法回顾性分析56例急性缺血性脑卒中患者临床资料,患者发病后24h内均接受颅脑CT平扫、CTA检查及数字减影血管造影(D SA)检查,以DSA诊断结果为"金标准"评价CTA在诊断患者脑动脉狭窄、脑侧支循环的诊断价值,并根据患者出院后90d随访情况,评价CTA的预后评估价值。结果 DSA检查显示56例患者中5例患者脑血管无狭窄,51例患者血管存在狭窄或闭塞;狭窄程度:无狭窄5例,轻度狭窄9例,中度狭窄11例,重度狭窄19例,闭塞12例。CTA检查显示6例患者脑血管无狭窄,50例患者血管存在狭窄或闭塞;狭窄程度:无狭窄6例,轻度狭窄8例,中度狭窄12例,重度狭窄17例,闭塞13例,CTA诊断脑血管狭窄/闭塞的总体符合率为82.14%(46/56),一致性评价Kappa=0.768(t=10.922,P<0.001)。DSA检查显示,56例患者中侧支循环良好25例,侧支循环不良31例;CTA检查显示,56例患者中侧支循环良好25例,侧支循环不良31例。CTA诊断侧支循环的灵敏度90.32%,特异度88.00%,准确率89.29%,阳性预测值90,32%,阴性预测值84.62%;预后良好患者CTA检查脑血管狭窄/闭塞情况及侧支循环情况优于预后不良患者,差异有统计学意义(P<0.05);Spearman相关性分析显示,CTA检查脑血管狹窄/闭塞程度、脑血管侧支循环情况与预后均呈正相关(r=0.454,0.337,P<0.05)。结论颅脑CTA在诊断急性缺血性脑卒中患者脑血管狭窄/闭塞程度及侧支循环中具有较高诊断效能,其诊断的脑血管狭窄/闭塞程度、侧支循环情况与预后呈正相关,可用于评估患者预后。

Value of Cranial CT Angiography in the Diagnosis and Prognosis Judgment of Patients with Acute Ischemic Stroke

Objective To explore the value of cranial CT angiography(CTA)in the diagnosis and prognosis judgment of patients with acute ischemic stroke.Methods The clinical data of 56 patients with acute ischemic stroke were analyzed retrospectively.All patients underwent cranial CT plain scan,CTA examination,and digital subtraction angiography(DSA)within 24h after the disease onset.The DSA diagnostic results were taken as a gold standard to evaluate the diagnostic value of CTA in the diagnosis of cerebral artery stenosis and collateral circulation of patients,and the evaluated value of CTA on prognosis was evaluated according to the 90d follow-up of patients after discharge.Results DSA examination showed that among 56 patients,there were 5 cases without cerebrovascular stenosis and 51 cases with vascular stenosis or occlusion,and stenosis degree showed there were 5 cases without stenosis,9 cases with mild stenosis,11 cases with moderate stenosis,19 cases with severe stenosis and 12 cases with occlusion.CTA examination showed 6 cases without cerebrovascular stenosis,50 cases with vascular stenosis or occlusion,and stenosis degree showed 6 cases without stenosis,8 cases with mild stenosis,12 cases with moderate stenosis,17 cases with severe stenosis,and 13 cases with occlusion.The overall coincidence rate of CTA diagnosis of cerebrovascular stenosis/occlusion was 82.14%(46/56),and the consistency evaluation showed Kappa=0.768(t=10.922,P<0.001).DSA examination showed that among 56 patients,there were 25 cases with good collateral circulation and 31 cases with poor collateral circulation.CTA examination showed 25 cases with good collateral circulation and 31 cases with poor collateral circulation.The sensitivity,specificity,accuracy rate,positive predictive value,and negative predictive value of CTA diagnosis of collateral circulation were 90.32%,88.00%,89.29%,90.32%,and 84.62%.The cerebrovascular stenosis/occlusion and collateral circulation by CTA examination among patients with good prognosis were better than those with poor prognosis(P<0.05).Spearman correlation analysis showed that the cerebrovascular stenosis/occlusion degree and cerebral collateral circulation by CTA examination were positively correlated with prognosis(r=0.454,0.337,P<0.05).Conclusion CTA has high diagnostic efficacy in diagnosing the cerebrovascular stenosis/occlusion degree and collateral circulation in patients with acute ischemic stroke.The diagnosis of cerebrovascular stenosis/occlusion degree and collateral circulation is positively correlated with prognosis and is available to assess the prognosis of patients.