急性缺血性脑卒中后临床结局的预测：重复非增强 CT、CT 血管造影和 CT 灌注的价值。
Prediction of Clinical Outcome After Acute Ischemic Stroke: The Value of Repeated Noncontrast Computed Tomography, Computed Tomographic Angiography, and Computed Tomographic Perfusion.
机构信息
From the Departments of Radiology (J.W.D., A.D.H., A.F.v.d.H., I.C.v.d.S., T.v.S., B.K.V.) and Neurology and Neurosurgery (L.J.K.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands.
出版信息
Stroke. 2017 Sep;48(9):2593-2596. doi: 10.1161/STROKEAHA.117.017835. Epub 2017 Jul 17.
BACKGROUND AND PURPOSE
Early prediction of outcome in acute ischemic stroke is important for clinical management. This study aimed to compare the relationship between early follow-up multimodality computed tomographic (CT) imaging and clinical outcome at 90 days in a large multicenter stroke study.
METHODS
From the DUST study (Dutch Acute Stroke Study), patients were selected with (1) anterior circulation occlusion on CT angiography (CTA) and ischemic deficit on CT perfusion (CTP) on admission, and (2) day 3 follow-up noncontrast CT, CTP, and CTA. Follow-up infarct volume on noncontrast CT, poor recanalization on CTA, and poor reperfusion on CTP (mean transit time index ≤75%) were related to unfavorable outcome after 90 days defined as modified Rankin Scale 3 to 6. Four multivariable models were constructed: (1) only baseline variables (model 1), (2) model 1 with addition of infarct volume, (3) model 1 with addition of recanalization, and (4) model 1 with addition of reperfusion. Area under the curves of the receiver operating characteristic curves of the models were compared using the DeLong test.
RESULTS
A total of 242 patients were included. Poor recanalization was found in 21%, poor reperfusion in 37%, and unfavorable outcome in 44%. The area under the curve of the receiver operating characteristic curve without follow-up imaging was 0.81, with follow-up noncontrast CT 0.85 (=0.02), CTA 0.86 (=0.01), and CTP 0.86 (=0.01). All 3 follow-up imaging modalities improved outcome prediction compared with no imaging. There was no difference between the imaging models.
CONCLUSIONS
Follow-up imaging after 3 days improves outcome prediction compared with prediction based on baseline variables alone. CTA recanalization and CTP reperfusion do not outperform noncontrast CT at this time point.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00880113.
背景与目的
急性缺血性脑卒中的早期预后预测对于临床管理非常重要。本研究旨在比较大型多中心脑卒中研究中，早期随访多模态计算机断层扫描（CT）成像与 90 天临床结局的关系。
方法
从 DUST 研究（荷兰急性脑卒中研究）中选择患者，入选标准为：（1）CT 血管造影（CTA）显示前循环闭塞，CT 灌注（CTP）显示缺血性缺损，（2）入院时行第 3 天的非增强 CT、CTP 和 CTA 随访。非增强 CT 随访梗死体积、CTA 显示差的再通和 CTP 显示差的再灌注（平均通过时间指数≤75%）与 90 天后改良 Rankin 量表 3-6 定义的不良结局相关。构建了 4 个多变量模型：（1）仅基线变量（模型 1），（2）在模型 1 中加入梗死体积，（3）在模型 1 中加入再通，（4）在模型 1 中加入再灌注。采用 DeLong 检验比较各模型受试者工作特征曲线下面积。
结果
共纳入 242 例患者。21%的患者再通不良，37%的患者再灌注不良，44%的患者预后不良。无随访影像的受试者工作特征曲线下面积为 0.81，随访非增强 CT 为 0.85（=0.02），CTA 为 0.86（=0.01），CTP 为 0.86（=0.01）。所有 3 种随访影像学方法均较无影像学检查改善预后预测，且均优于单纯基于基线变量的预测。影像学模型之间无差异。
结论
与单纯基于基线变量的预测相比，3 天后的随访影像学可改善预后预测。此时 CTA 再通和 CTP 再灌注并不优于非增强 CT。
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