单期和多期CT血管造影评估缺血性脑卒中患者侧支状态与CT灌注参数的对比性研究

目的 对于急性缺血性脑卒中(AIS)大脑中动脉闭塞患者,比较单时相、多时相CT血管造影(sCTA、mC-TA)评估的侧支循环评分与定量灌注参数之间的关联性及在预测临床预后中的价值.方法 搜集2019年12月至2020年12月于急救中心行一站式CT检查的发病时间在24 h内的大脑中动脉闭塞患者的临床资料及影像学资料,从C...

A Comparative Study of Single-Phase and Multi-Phase CT Angiography in Evaluating Collateral Status and CT Perfusion Parameters in Patients with Ischemic Stroke

Objective To compare collateral status on single-phase CT angiography( sC TA) and multiphase CT angiography( mC TA) and the CT perfusion parameters in acute ischemic stroke patients with middle cerebral artery occlusion and to explore theirinter-rater reliability and intra-observer agreement in assessing collateral circulation and ability of predicting clinical outcomes. Methods Consecutive patients who underwent multimodal CT examination( including NCCT,CTP,and CTA) presenting to our institution within 24 hours after onset of stroke. In this study,acute stroke imaging and clinical outcome data were obtained. The peak arterial phase imaging reconstructed from CTP original image is defined as sC TA. The peak arterial phase,the peak venous phase,and late venous phases were defined as mC TA. The statuses of collateral circulation were scored on a scale of 0-5 according tothesystem described by Menon,and evaluated the reliability of inter-raters.The sC TA and mC TA were divided into good collateral status group and poor collateral status group,and the differences in ischemic core volume,hypoperfusion volume,final infarct volume,National Institutes of Health Stroke Scale( NIHSS)score,onset-to-scantime,and modified Rankin Scale at 3 months score( mRS) were counted and analyzed between the two groups. Results The final analysis included 43 patients( 29 men,average age 66. 63 ± 13. 17 years). Inter-rater reliability for sC TA and mC TA are excellent( the Kappa values were 0. 712 and 0. 723). Compared with mC TA,sC TA underestimated collateral status. sC TA showed that 23. 3% had good collateral status,while 55. 8% patients with mC TA had good collateral status. Single-and multi-phase CT angiography scores were negatively correlated with ischemic core volume( r =-0.345;P = 0. 023;r =-0. 697;P = 0. 006). Both single-and multiple-phase CT angiography scores had a moderate negative correlation with final infarct volume( r =-0. 400;P = 0. 008;r =-0. 540,P = 0. 000). Conclusion For patients with middle cerebral artery occlusion acute ischemic stroke,multi-phase CT angiography performed better than single-phase CT angiography in assessing collateral circulation condition. The collateral circulation score based on mC TA will help predict the functional prognosis of patients.