灌注计算机断层扫描在预测急性缺血性脑卒中患者功能转归中的应用
Perfusion computed tomography in prediction of functional outcome in patients with acute ischaemic stroke.
作者信息
Arkuszewski Michał, Swiat Maciej, Opala Grzegorz
机构信息
Department of Neurology, Central University Hospital, Medical University of Silesia, Katowice, Poland.
出版信息
Nucl Med Rev Cent East Eur. 2009;12(2):89-94.
PURPOSE
To determine the value of perfusion computed tomography (CT) in prediction of the clinical course and late functional outcome in patients with acute ischaemic stroke who had unremarkable initial brain CT examination.
MATERIAL AND METHODS
Single slice perfusion CT was performed in 55 consecutive patients (27 women, mean age 67 +/- 11 years) with acute ischaemic stroke within 6 hours (median 2.26 hours) from onset of symptoms. Values of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) obtained from affected hemisphere were compared to respective values in non-affected hemisphere (relative parameters). Initial neurological deficits were estimated using NIH Stroke Scale (NIHSS) score and correlated with perfusion CT values, employing Spearman rank correlation coefficient (r). Values of perfusion CT parameters in prediction of functional outcome were determined by comparing against scores on modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS) after three months of onset of stroke.
RESULTS
All perfusion CT parameters significantly correlated with initial neurological deficit. The highest correlation with the NIHSS was found for relative CBF, which correlated better than absolute CBF (rCBF r = 0.69; CBF r = 0.50, P < 0.001). In prediction of favourable outcome (mRS <or= 2) the commonly employed thresholds (in parentheses) and associated sensitivity, specificity, positive and negative predictive values were: 87%, 44%, 79%, and 58% for CBF (10 ml/min/100 g), 59%, 81%, 88%, and 49% for rCBF (48%), 49%, 56%, 73%, and 31% for CBV (2 ml/100 g), 87%, 44%, 79% and 58% for rCBV (60%), 41%, 81%, 84% and 36% for MTT (6 s) and 54%, 81%, 87% and 49% for rMTT (145%), respectively, while for prediction of excellent outcome (mRS <or= 1), the only statistically significant respective accuracy measures were for rCBV, 90%, 35%, 60%, 75%, and for rCBF, 62%, 69%, 69% and 62%.
CONCLUSIONS
In patients within the first 6 hours from stroke onset, and without a hypodensity sign on initial routine CT examination, perfusion CT provides quantitative parameters that correlate well with initial neurological status and late functional outcome.
目的
确定灌注计算机断层扫描（CT）在预测初始脑部CT检查无异常的急性缺血性脑卒中患者临床病程及远期功能转归中的价值。
材料与方法
对55例（27例女性，平均年龄67±11岁）急性缺血性脑卒中患者于症状发作6小时内（中位数2.26小时）进行单层灌注CT检查。将患侧半球的脑血流量（CBF）、脑血容量（CBV）和平均通过时间（MTT）值与对侧半球的相应值（相对参数）进行比较。使用美国国立卫生研究院卒中量表（NIHSS）评分评估初始神经功能缺损，并采用Spearman等级相关系数（r）将其与灌注CT值相关联。通过与卒中发作三个月后的改良Rankin量表（mRS）和格拉斯哥预后量表（GOS）评分进行比较，确定灌注CT参数在预测功能转归中的价值。
结果
所有灌注CT参数均与初始神经功能缺损显著相关。相对CBF与NIHSS的相关性最高，其相关性优于绝对CBF（相对CBF r = 0.69；CBF r = 0.50，P < 0.001）。在预测良好转归（mRS≤2）时，常用阈值（括号内）及相关的敏感性、特异性、阳性和阴性预测值分别为：CBF（10 ml/min/100 g）为87%、44%、79%和58%；相对CBF（48%）为59%、81%、88%和49%；CBV（2 ml/100 g）为49%、56%、73%和31%；相对CBV（60%）为87%、44%、79%和58%；MTT（6秒）为41%、81%、84%和36%；相对MTT（145%）为54%、81%、87%和49%。而在预测优异转归（mRS≤1）时，唯一具有统计学意义的相应准确性指标分别为相对CBV，90%、35%、60%、75%；相对CBF，62%、69%、69%和62%。
结论
对于卒中发作6小时内且初始常规CT检查无低密度征象的患者，灌注CT可提供与初始神经状态及远期功能转归相关性良好的定量参数。
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