CT 灌注在急性缺血性脑卒中患者的治疗分配中有帮助吗？专家意见分析。
Is CT perfusion helpful in the treatment allocation of patients with acute ischemic stroke? An expert-opinion analysis.
机构信息
Neurology Unit.E.O. Ospedali Galliera, Via Mura delle Cappuccine 14, 16128, Genoa, Italy.
Neurology Department, Rabin Medical Center, Petach Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
出版信息
Neurol Sci. 2017 Oct;38(10):1771-1777. doi: 10.1007/s10072-017-3051-1. Epub 2017 Jul 19.
BACKGROUND
Intravenous tPA is the standard treatment for acute ischemic stroke within 4.5 hours of symptom onset. Neuroradiological selection is currently based upon non-contrast- brain CT scan (NCCT).
AIMS
To verify, in an "expert-opinion setting", the possible usefulness of CT perfusion (CTP) in decision-making toward i.v. thrombolysis.
PATIENTS AND METHOD
One hundred and three consecutive patients with acute ischemic stroke who underwent NCCT and CTP were re-evaluated by an expert in cerebrovascular disease, to verify if adding CTP information would have changed expert's opinion.
RESULTS
After CTP, a definitive decision was made for 20 more patients, changing the proportion of patients candidate to i.v. tPA from 44% to 51%, and reducing uncertainty from 29% to 10%. CTP results were useful inmilder stroke (p = 0.01).
CONCLUSIONS
In a "real world" setting, CT perfusion could be useful for clinical decision, in particular for milder stroke.
背景
静脉注射重组组织型纤溶酶原激活剂（tPA）是发病 4.5 小时内急性缺血性脑卒中的标准治疗方法。神经影像学选择目前基于非对比脑 CT 扫描（NCCT）。
目的
在“专家意见设置”中验证 CT 灌注（CTP）在静脉溶栓决策中的可能作用。
患者和方法
103 例连续急性缺血性脑卒中患者接受 NCCT 和 CTP 检查，由脑血管病专家重新评估，以验证添加 CTP 信息是否会改变专家的意见。
结果
在 CTP 后，又有 20 名患者做出了明确的决定，将适合静脉注射 tPA 的患者比例从 44%提高到 51%，并将不确定性从 29%降低到 10%。CTP 结果对轻度卒中更有用（p=0.01）。
结论
在“真实世界”环境中，CT 灌注对于临床决策可能有用，特别是对于轻度卒中。
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