CT灌注源图像在诊断超急性期缺血性脑卒中的应用价值

目的 探讨CT灌注源图像(CTPSI)在超急性期缺血性脑卒中诊断中的临床应用价值.方法 100例急性缺血性脑卒中(发病时间＜9 h)的患者行一站式CT检查,根据动脉期与静脉期CTPSI Alberta卒中早期CT评分(ASPECTS)的不同将100例患者分为2组:有延迟灌注组和无延迟灌注组.分析基线平扫CT、动脉期及静脉期CTPSI ASPECTS,并与随访影像AS-PECTS进行对照.Wilcoxon秩和检验比较动脉期CTP SI与静脉期CTPSI ASPECTS之间的统计学差异;应用多元线性回归分析基线一站式CT各个影像学形态ASPECTS与随访影像ASPECTS之间的线性依存关系.结果 100例患者分为有延迟灌注组42例和无延迟灌注组58例.基线平扫CT、动脉期、静脉期和随访影像的ASPECTS中位数(最小值～最大值)在有延迟灌注组分别为:8.0(6.0～10.0)、7.0(1.0～8.0)、8.0(3.0～10.0)、7.5(0～10.0);在无延迟灌注组分别为:8.0(1.0～10.0)、7.5(1.0～10.0)、8.5(1.0～10.0)、7.0(0～10.0).在无延迟灌注组,动脉期与静脉期CTPSI ASPECTS差异无统计学意义(Z=-1.00,P=0.459),而在有延迟灌注组,两者差异有统计学意义(Z=-3.08,P=0.001).在无延迟灌注组,基线影像ASPECTS(平扫CT、动脉期及静脉期CTPSI)与随访影像AS-PECTS均存在正相关(r值分别为0.879、0.902、0.945,P值均＜0.01);在有延迟灌注组,静脉期CTPSI与随访影像ASPECTS的相关性最好(r=0.831,P=0.004).多元线性回归结果显示只有静脉期CTPSI与随访影像ASPECTS之间的线性关系有统计学意义:无延迟灌注组,标准化回归系数β=0.946,P＜0.001;有延迟灌注组,β=0.714,P=0.003.结论 CTPSI显示无延迟灌注者不存在缺血半暗带,提示不适合溶栓治疗;有延迟灌注者提示存在缺血半暗带,是溶栓治疗的重要依据之一.

Diagnostic value of perfusion source images in hyperacute stroke

Objective To investigate the diagnostic value of CT perfusion source images (CTPSI) in acute stroke less than 9 hours. Methods One-stop shopCT examination were performed in 100 patients with symptoms of acute stroke in less than 9 hours. Patients were divided into two groups according to with and without delayed perfusion on CTPSI, and compared Alberta stroke program early CT score study (ASPECTS) scores on non-contrast CT, arterial phase CTPSI and venous phase CTPSI with follow-up imaging. The ASPECTS were analyzed on arterial phase CTPSI and venous phase CTPSI using Wilcoxon rank-sum test, then compared with the follow up imaging ASPECTS using multiple linear regressions. Results The median (min-max) scores of ASPECTS on NCCT, arterial phase CTPSI, venous phase CTPSI and follow-up imaging were 8,0 (6.0-10.0), 7.0 (1.0-8.0), 8.0 (3.0-10.0) and 7.5 (0-10.0) in group with delayed perfusion, respectively, and 8.0 (1.0-10.0), 7.5 (1.0-10.0), 8.5 (1.0-10.0) and 7.0 (0-10.0) in group without delayed perfusion respectively. ASPECTS scores measured on arterial phase CTPSI did not differ with venous phase CTPSI group without delayed per-fusion (Z=- 1.00,P=0.459),while there was statistic difference in group with delayed peffusion(Z=-3.08,P=0.001).There were significant correlation of ASPECTS scores measured on mon-contrast CT, arterial phase CTPSI and venous phase CTPSI to follow-up imaging ASPECTS (r=0.879, 0.902, 0.945, P＜0.01) in group without delayed perfusion; ASPECTS measured in venous phase CTPSI showed the best correlation to follow-up imaging ASPECTS (r=0.831, P=0.004) in group with delayed perfusion. Multiple linear regression showed that the correlation in only venous phase CTPSI with follow-up imaging ASPECTS was statistically significant: in group without delayed perfusion,β=0.946, P＜0.001; in group with delayed perfusion,β=0.714,P=0.003. Conclusion Presence of delayed perfusion in CTPSI is quit important in identifying ischemic penumbra, which plays a critical role in imaging-guided thrombolytic therapy.