脑血容量损伤程度可预测椎基底动脉闭塞患者的功能结局。
Cerebral blood volume lesion extent predicts functional outcome in patients with vertebral and basilar artery occlusion.
机构信息
1 Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
2 Department of Neuroscience, University Hospital of "Tor Vergata", Rome, Italy.
出版信息
Int J Stroke. 2019 Jul;14(5):540-547. doi: 10.1177/1747493017744465. Epub 2017 Nov 21.
BACKGROUND
CT perfusion may improve diagnostic accuracy in posterior circulation stroke. The posterior circulation Acute Stroke Prognosis Early CT score (pc-ASPECTS) on Computed Tomography Angiography source images (CTA-SI) predicts functional outcome in patients with basilar artery occlusion.
AIMS
We assessed the prognostic value of pc-ASPECTS on CT perfusion in patients with vertebral and basilar artery occlusion (VBAO) in comparison with CTA-SI.
METHODS
Whole-brain CT perfusion from consecutive stroke patients with VBAO at four stroke centers was retrospectively analyzed. pc-ASPECTS - a 10-point score assessing hypoattenuation on CTA-SI - was calculated from CT perfusion parameters as focally reduced cerebral blood flow or cerebral blood volume, focally increased time to peak of the deconvolved tissue residue function (Tmax) or mean transit time. Two investigators independently reviewed the images. Reliability was assessed with intraclass correlation coefficient. Good outcome was defined as modified Rankin scale ≤3 at three months.
RESULTS
We included 60 patients with VBAO. After assessment of four CT perfusion maps simultaneously, area-under-ROC curve (AROC) was 0.83 (95%CI 0.72-0.93) for cerebral blood volume, 0.76 (95%CI 0.64-0.89) for cerebral blood flow, 0.77 (95%CI 0.64-0.89) for Tmax, 0.70 (95%CI 0.56-0.84) for mean transit time versus area-under-ROC curve 0.64 (95%CI 0.50-0.79) for CTA-SI. Cerebral blood volume had greater accuracy compared with CTA-SI for poor outcome (p = 0.04). In logistic regression analysis, cerebral blood volume pc-ASPECTS≤8 was independently associated with poor outcome (OR 9.3 95%CI 2.2-41; p = 0.003, adjusted for age and clinical severity). Inter-rater agreement was substantial for cerebral blood volume pc-ASPECTS (intraclass correlation coefficient 0.82 95%CI 0.71-0.90 versus 0.67 for CTA-SI 95%CI 0.43-0.81).
CONCLUSIONS
Cerebral blood volume pc-ASPECTS may identify VBAO patients at higher risk of disability.
背景
CT 灌注成像可提高后循环卒中的诊断准确性。基于 CT 血管造影源图像（CTA-SI）的后循环急性卒中预后早期 CT 评分（pc-ASPECTS）可预测基底动脉闭塞患者的功能结局。
目的
我们评估了 CT 灌注成像在椎基底动脉闭塞（VBAO）患者中的预后价值，并与 CTA-SI 进行了比较。
方法
回顾性分析了来自四家卒中中心的 VBAO 连续卒中患者的全脑 CT 灌注成像。pc-ASPECTS 是一种 10 分评分，用于评估 CTA-SI 上的低衰减，评分基于 CT 灌注参数，包括局部脑血流或局部脑血容量减少、局部达峰时间（Tmax）或平均通过时间延长。两位研究者独立阅片。采用组内相关系数评估可靠性。改良Rankin 量表（mRS）评分≤3 定义为预后良好。
结果
我们纳入了 60 例 VBAO 患者。在同时评估 4 张 CT 灌注图后，脑血容量的受试者工作特征曲线下面积（AUC）为 0.83（95%CI 0.72-0.93），脑血流为 0.76（95%CI 0.64-0.89），Tmax 为 0.77（95%CI 0.64-0.89），平均通过时间为 0.70（95%CI 0.56-0.84），而 CTA-SI 的 AUC 为 0.64（95%CI 0.50-0.79）。脑血容量预测不良结局的准确性优于 CTA-SI（p=0.04）。在 logistic 回归分析中，脑血容量 pc-ASPECTS≤8 与不良结局独立相关（OR 9.3，95%CI 2.2-41；p=0.003，校正年龄和临床严重程度后）。脑血容量 pc-ASPECTS 的观察者间一致性较高（组内相关系数 0.82，95%CI 0.71-0.90，而 CTA-SI 为 0.67，95%CI 0.43-0.81）。
结论
脑血容量 pc-ASPECTS 可能识别出更易发生残疾的 VBAO 患者。
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