Acute Stroke: Prognostic Value of Quantitative Collateral Assessment at Perfusion CT
Acute Stroke: Prognostic Value of Quantitative Collateral Assessment at Perfusion CT
复制标题
急性中风：灌注 CT 定量并行评估的预后价值
DOI：
10.1148/radiol.2019181510
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发表时间：
2019-03-01
期刊：
影响因子：
19.7
通讯作者：
Lou, Min
中科院分区：
文献类型：
--
作者：
Shi, Feina;Gong, Xiaoxian;Lou, Min
目的：建立CT侧支血流灌注定量评价方法，探讨其对急性缺血性脑卒中预后的预测价值。材料与方法：本回顾性研究回顾了2009年5月至2017年8月期间连续接受预处理灌注CT治疗的AIS患者和大脑中动脉M1段闭塞患者的数据。计算每位患者侧裂内侧支血管的最大脑血流量（CBF） （cCBF(max)）。90天的改良Rankin量表评分为0-2分，即为良好预后。采用多变量logistic回归分析确定cCBF（max）与(a)出血转化和(b)临床结局之间的关系。结果：最终分析纳入204例患者（中位年龄73岁；四分位数范围62-80岁；女性82例（40.2%））。多变量logistic回归分析显示，较高的cCBF（max）是以下因素的独立预测因子：(a)在调整基线美国国立卫生研究院卒中量表（NIHSS）、血管内血栓切除术、基线梗死核体积和再通后，出血转化风险较低（优势比[OR]， 0.99； 95%可信区间[CI]: 0.98, 1.00; P = 0.009）； (b)预后较好(OR, 1.02; 95% CI: 1.01, 1.03；P = .001)，分别校正年龄、基线NIHSS评分、血管内取栓、高血压、基线梗死核体积和再通。结论：在灌注CT上测量侧枝血管的最大脑血流量是一种可行的定量侧枝血流评估方法。急性缺血性脑卒中患者侧支血管最大脑血流量与临床预后相关。(c) rsna, 2019
Purpose: To develop a quantitative assessment of collateral perfusion at CT and to investigate its value in the prediction of outcome in patients with acute ischemic stroke (AIS).Materials and Methods: This retrospective study reviewed data from consecutive patients with AIS and an occluded M1 segment of the middle cerebral artery who underwent pretreatment perfusion CT between May 2009 and August 2017. The maximum cerebral blood flow (CBF) of collateral vessels (cCBF(max)) within the Sylvian fissure was calculated for each patient. Good outcome was defined as a 90-day modified Rankin scale score of 0-2. Multivariable logistic regression analysis was used to determine the relationship between cCBF(max) and (a) hemorrhagic transformation and (b) clinical outcome.Results: The final analysis included 204 patients (median age, 73 years; interquartile range, 62-80 years; 82 [40.2%] women). Multivariable logistic regression analysis showed that higher cCBF(max) was an independent predictor for (a) a lower risk of hemorrhagic transformation (odds ratio [OR], 0.99; 95% confidence interval [CI]: 0.98, 1.00; P = .009) after adjusting for baseline National Institutes of Health Stroke Scale (NIHSS), endovascular thrombectomy, baseline infarct core volume, and recanalization and (b) better outcome (OR, 1.02; 95% CI: 1.01, 1.03; P = .001) after adjusting for age, baseline NIHSS score, endovascular thrombectomy, hypertension, baseline infarct core volume, and recanalization, respectively.Conclusion: The measurement of maximum cerebral blood flow of collateral vessels within the Sylvian fissure is a feasible quantitative collateral assessment at perfusion CT. Maximum cerebral blood flow of collateral vessels was associated with clinical outcome in patients with acute ischemic stroke. (C) RSNA, 2019