Liu Z W, Jiang Y, Wang R, Lu J, Qi P, Cao R Y, Zhang L, Shen Z Y, Chen J
Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2018 Jun 5;98(21):1697-1702. doi: 10.3760/cma.j.issn.0376-2491.2018.21.015.
To explore the significance of multi-parameter semiquantitative Alberta Stroke Program Early CT Score (ASPECTS) in detecting core infarction in acute ischemic stroke (AIS) patients. Twenty-one consecutive AIS patients from Beijing Hospital were retrospectively reviewed in this study from August 2016 to August 2017. All the patients presented within 6 hours since symptom onset.All the patients underwent one-stop dynamic whole brain 4D CTA-CTP scan before treatments (intravenous thrombolysis, mechanical thrombectomy, or other endovascular recanalization). MRI scan was performed in all patients 3 to 7 days after initial administration. Multi-parameter ASPECTS was calculated on the affected hemisphere regarding noncontrast CT (NCCT) map, cerebral blood flow (CBF) map, cerebral blood volume (CBV) map, mean transit time (MTT) map and MRI-DWI map by subtracting 1 point from 10 for any abnormalities visually detected. The evaluative consistency and diagnostic efficiency were analyzed by χ(2) test, identity test, and ' coefficient of concordance using IBM SPSS statistics 22.0 software. Compared with DWI-ASPECTS or follow-up NCCT-ASPECTS, CBV-ASPECTS had the best performance on both the identity test ( coefficient κ=0.74)and coefficient of concordance (τ=0.70). All the values of sensitivity (77.8%), specificity (95.5%), positive likelihood ratio (17.27) and AUC(0.87)were the highest in CBV-ASPECTS, followed by dMTT-ASPECTS. Meanwhile, the misdiagnosis rate (4.5%), missed diagnosis rate (22.2%) and negative likelihood ratio were the lowest in CBV-ASPECTS, followed by dMTT-ASPECTS. dMTT-ASPECTS had the same specificity(95.5%) as CBV-ASPECTS did and it could reveal the infarction in the areas where CBV map showed normal. NCCT-ASPECTS had the lowest sensitivity (64.7%) and highest missed diagnosis rate (35.3%). The misdiagnosis rate of CBF-ASPECTS was the highest (25.2%) and AUC was the lowest (0.76). Multi-parameter semiquantitative ASPECTS may predict the infarction accurately in AIS patients. Compared with the single parameter of NCCT-ASPECTS, this new method may have better detectability and diagnostic performance.
探讨多参数半定量阿尔伯塔卒中项目早期CT评分（ASPECTS）在检测急性缺血性卒中（AIS）患者核心梗死灶方面的意义。本研究回顾性分析了2016年8月至2017年8月北京医院连续收治的21例AIS患者。所有患者均在症状发作后6小时内就诊。所有患者在治疗前（静脉溶栓、机械取栓或其他血管内再通治疗）均接受一站式动态全脑4D CTA-CTP扫描。所有患者在初次给药后3至7天进行MRI扫描。通过对患侧半球的非增强CT（NCCT）图、脑血流量（CBF）图、脑血容量（CBV）图、平均通过时间（MTT）图和MRI-DWI图进行多参数ASPECTS计算，对任何肉眼可见的异常从10分中减去1分。使用IBM SPSS statistics 22.0软件通过χ(2)检验、一致性检验和一致性系数分析评估的一致性和诊断效率。与DWI-ASPECTS或随访NCCT-ASPECTS相比，CBV-ASPECTS在一致性检验（一致性系数κ=0.74）和一致性系数（τ=0.70）方面表现最佳。CBV-ASPECTS的所有敏感度（77.8%）、特异度（95.5%）、阳性似然比（17.27）和AUC（0.87）值均最高，其次是dMTT-ASPECTS。同时，CBV-ASPECTS的误诊率（4.5%）、漏诊率（22.2%）和阴性似然比最低，其次是dMTT-ASPECTS。dMTT-ASPECTS与CBV-ASPECTS具有相同的特异度（95.5%），并且可以显示CBV图显示正常区域的梗死灶。NCCT-ASPECTS的敏感度最低（64.7%），漏诊率最高（35.3%）。CBF-ASPECTS的误诊率最高（25.2%），AUC最低（0.76）。多参数半定量ASPECTS可以准确预测AIS患者的梗死灶。与NCCT-ASPECTS单参数相比，这种新方法可能具有更好的可检测性和诊断性能。
