[1]李雪娇,聂君洋,谢艺才,等.一站式多模态CT评估急性缺血性脑卒中侧支循环及预后[J].中国医学物理学杂志,2025,42(4):471-478.[doi:10.3969/j.issn.1005-202X.2025.04.008]
　LI Xuejiao,NIE Junyang,XIE Yicai,et al.One-stop multi-modality CT to assess collateral circulation and prognosis in acute ischemicstroke[J].Chinese Journal of Medical Physics,2025,42(4):471-478.[doi:10.3969/j.issn.1005-202X.2025.04.008]
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一站式多模态CT评估急性缺血性脑卒中侧支循环及预后()

《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
42
期数:
2025年第4期
页码:
471-478
栏目:
医学影像物理
出版日期:
2025-04-20

文章信息/Info

Title:
One-stop multi-modality CT to assess collateral circulation and prognosis in acute ischemicstroke
文章编号:
1005-202X（2025）04-0471-08
作者:
李雪娇; 聂君洋; 谢艺才; 黄军荣; 苏泓燕
梧州市红十字会医院放射科，广西 梧州 543000
Author(s):
LI Xuejiao;  NIE Junyang;  XIE Yicai;  HUANG Junrong;  SU Hongyan
Department of Radiology, Wuzhou Red Cross Hospital, Wuzhou 543000, China
关键词:
一站式; 多模态; 计算机断层扫描成像; 急性缺血性脑卒中; 侧支循环
Keywords:
one-stop;  multi-modality;  computed tomography;  acute ischemic stroke;  collateral circulation
分类号:
R743.3；R816.1
DOI:
10.3969/j.issn.1005-202X.2025.04.008
文献标志码:
A
摘要:
目的：探讨一站式多模态CT在急性缺血性脑卒中（AIS）侧支循环评估及预后判断中的应用效果。方法：纳入2022年2月~2024年5月在梧州市红十字会医院就诊的AIS患者115例为研究对象，患者入院时均进行一站式多模态CT检查，并行血管内治疗。分别依据多时相CT血管成像（mCTA）侧支循环评分量表及90 d改良Rankin量表（mRs）评分将患者分为侧支循环良好组（n=59）、侧支循环不良组（n=56）和预后良好组（n=48）、预后不良组（n=67），对各组间临床资料及影像学参数进行对比，AIS患者侧支循环情况及预后的独立影响因素通过多因素Logistic回归模型分析，基于多因素Logistic分析建立AIS患者预后不良预测模型，通过受试者工作特征（ROC）曲线分析预测模型对AIS患者预后的预测价值。结果：侧支循环不良组岛带征及脑灰白质模糊征比例高于侧支循环良好组（P<0.05），而低灌注强度比值（HIR）<0.3低于侧支循环良好组（P<0.05）；侧支循环不良组患者局部血容量（rCBV）<40%、脑血流量（rCBF）<30%、达峰时间（Tmax）>8 s、Tmax>10 s体积均高于侧支循环良好组（P<0.05），而ASPECTS评分低于侧支循环良好组（P<0.05）；多因素Logistic回归分析显示，ASPECTS评分、rCBV<40%、rCBF<30%、Tmax>10 s是侧支循环不良的独立风险因素（P<0.05）。预后不良组患者介入取栓术后出血、Mismatch比值<1.8比例高于预后良好组（P<0.05），而HIR<0.3低于预后良好组（P<0.05）；预后不良组患者的入院NIHSS评分、rCBV<40%、rCBF<30%、Tmax>4 s、Tmax>6 s、Tmax>10 s体积均高于预后良好组（P<0.05），而mCTA侧支循环评分低于预后良好组（P<0.05）。多因素 Logistic 回归分析显示，入院 NIHSS 评分、mCTA 侧支循环评分、rCBV<40%、rCBF<30%及Tmax>10 s是预后不良的独立风险因素（P<0.05），带入回归方差：Logit(P)=-0.184+入院NIHSS评分×0.134+mCTA 侧支循环评分×（-0.415）+rCBV<40%×0.107+rCBF<30%×0.089+Tmax>10 s×0.028；ROC 曲线结果显示，基于多因素Logistic回归模型预测AIS患者预后不良的曲线下面积为0.775（95 CI：0.689~0.860，P<0.001）。结论：一站式多模态CT评估AIS患者侧支循环及预后具有较好的应用价值。
Abstract:
Objective To investigate the potential of one-stop multi-modality CT in the assessment of collateral circulationand prognosis in acute ischemic stroke (AIS). Methods From February 2022 to May 2024, 115 patients diagnosed with AISat Wuzhou Red Cross Hospital were enrolled in the study. All subjects were examined with one-stop multi-modality CT atadmission and received endovascular therapy. According to the collateral circulation score derived from multi-phase CTangiography (mCTA) and the modified Rankin scale score at 90 days, these patients were divided into different groups: good(n=59) vs poor (n=56) collateral circulation groups, and favorable (n=48) vs unfavorable (n=67) outcome groups. Clinicaland imaging parameters were compared between these groups. Independent risk factors for collateral circulation andprognosis of AIS patients were identified through multivariate Logistic regression analysis. A prediction model forunfavorable AIS prognosis was developed based on the results of multivariate Logistic analysis, and its predictive value wasassessed using receiver operating characteristic (ROC) curve analysis. Results Poor collateral circulation group exhibitedhigher proportions of insular ribbon and gray-white matter junction blurring as compared with good collateral circulation group (P<0.05), while the ratio of hypoperfusion intensity ratio (HIR) <0.3 was lower in poor collateral circulation group(P<0.05). Relative cerebral blood volume (rCBV) <40%, relative cerebral blood flow (rCBF) <30%, peak time (Tmax) >8 s,and Tmax>10 s volume were all significantly higher in poor collateral circulation group (P<0.05), whereas the Alberta strokeprogram early CT score (ASPECTS) was lower (P<0.05). Multivariate Logistic regression analysis identified ASPECTS,rCBV <40%, rCBF <30%, and Tmax>10 s as independent risk factors for poor collateral circulation (P<0.05). Unfavorableoutcome group had higher rates of hemorrhage following endovascular thrombectomy and mismatch ratio <1.8 thanfavorable outcome group (P<0.05), with a lower HIR<0.3 ratio (P<0.05). Compared with favorable outcome group,unfavorable outcome group also showed higher admission NIHSS scores, higher percentages of rCBV <40%, rCBF <30%,Tmax>4 s, Tmax>6 s, and Tmax>10 s volumes (P<0.05), but lower mCTA collateral circulation score (P<0.05). MultivariateLogistic regression analysis indicated that admission NIHSS score, mCTA collateral circulation score, rCBV <40%, rCBF<30%, and Tmax>10 s were independent risk factors for unfavorable outcomes (P<0.05). The regression equation wasformulated as: Logit(P) =-0.184+ (admission NIHSS score×0.134) + (mCTA collateral circulation score×-0.415) + (rCBV <40%×0.107)+(rCBF<30%×0.089)+(Tmax>10 s×0.028). ROC curve analysis demonstrated an area under the curve of 0.775(95 CI: 0.689-0.860, P<0.001) for the prediction model in assessing unfavorable AIS prognosis. Conclusion One-stop multimodality CT has significant application value in assessing collateral circulation and predicting prognosis in AIS patients.

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备注/Memo

备注/Memo:
【收稿日期】2024-10-12【基金项目】广西壮族自治区卫生健康委员会科研项目（Z-D20221732）【作者简介】李雪娇，副主任医师，研究方向：放射诊断，E-mail: wzfsk3855246@163.com
更新日期/Last Update: 2025-04-30