Kloska Stephan P, Dittrich Ralf, Fischer Tobias, Nabavi Darius G, Fischbach Roman, Seidensticker Peter, Osada Nani, Ringelstein E Bernd, Heindel Walter
Department of Clinical Radiology, University of Münster, Albert-Schweitzer-Str 33, 48149, Münster, Germany.
Eur Radiol. 2007 Oct;17(10):2491-8. doi: 10.1007/s00330-007-0696-9. Epub 2007 Jun 5.
This study evaluated perfusion computed tomography (PCT) for the prediction of vessel recanalization and clinical outcome in patients undergoing intravenous thrombolysis. Thirty-nine patients with acute ischemic stroke of the middle cerebral artery territory underwent intravenous thrombolysis within 3 h of symptom onset. They all had non-enhanced CT (NECT), PCT, and CT angiography (CTA) before treatment. The Alberta Stroke Program Early Computed Tomography (ASPECT) score was applied to NECT and PCT maps to assess the extent of ischemia. CTA was assessed for the site of vessel occlusion. The National Institute of Health Stroke Scale (NIHSS) score was used for initial clinical assessment. Three-month clinical outcome was assessed using the modified Rankin scale. Vessel recanalization was determined by follow-up ultrasound. Of the PCT maps, a cerebral blood volume (CBV) ASPECT score of >6 versus < or =6 was the best predictor for clinical outcome (odds ratio, 31.43; 95% confidence interval, 3.41-289.58; P < 0.002), and was superior to NIHSS, NECT and CTA. No significant differences in ASPECT scores were found for the prediction of vessel recanalization. ASPECT score applied to PCT maps in acute stroke patients predicts the clinical outcome of intravenous thrombolysis and is superior to both early NECT and clinical parameters.
本研究评估了灌注计算机断层扫描（PCT）在预测接受静脉溶栓治疗患者的血管再通情况及临床结局中的作用。39例大脑中动脉区域急性缺血性卒中患者在症状发作3小时内接受了静脉溶栓治疗。治疗前，他们均接受了非增强CT（NECT）、PCT及CT血管造影（CTA）检查。将阿尔伯塔卒中项目早期计算机断层扫描（ASPECT）评分应用于NECT和PCT图像，以评估缺血范围。对CTA评估血管闭塞部位。使用美国国立卫生研究院卒中量表（NIHSS）评分进行初始临床评估。采用改良Rankin量表评估3个月时的临床结局。通过随访超声确定血管再通情况。在PCT图像中，脑血容量（CBV）ASPECT评分>6与≤6相比，是临床结局的最佳预测指标（比值比，31.43；95%置信区间，3.41 - 289.58；P < 0.002），且优于NIHSS评分、NECT及CTA。在预测血管再通方面，ASPECT评分未发现显著差异。应用于急性卒中患者PCT图像的ASPECT评分可预测静脉溶栓的临床结局，且优于早期NECT及临床参数。
