Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, China; Department of Radiology, Beijing Hospital, National Center of Gerontology, No.1, DaHua Road, Dong Dan, Beijing 100730, China.
Department of Neurology, Beijing Hospital, National Center of Gerontology, China.
Acad Radiol. 2020 May;27(5):696-703. doi: 10.1016/j.acra.2019.06.013. Epub 2019 Jul 16.
To describe the application of time maximum intensity projection CTA (t-MIP CTA) in acute ischemic stroke and compare t-MIP CTA and single-phase CTA (sCTA) in assessing collateral circulation and predicting prognosis.
Twenty-nine acute ischemic stroke patients who underwent one-stop CT angiography (CTA)-CT perfusion scan were reviewed retrospectively. sCTA and t-MIP CTA were developed by CT perfusion scanning data. Image quality and collateral circulation were compared between the sCTA and t-MIP CTA groups. CT attenuation values, image noise, signal to noise , contrast to noise, and subjective image quality were obtained and compared between these two groups. The correlations of clinical prognosis and infarct volume with collateral status on t-MIP CTA and sCTA were analyzed, separately. Receiver operating characteristic curve was used to reveal the sensitivity and specificity of t-MIP CTA and sCTA in predicting outcome.
All images exhibited good quality for diagnosis. In objective evaluation, the noise level of t-MIP CTA was significantly lower than that of sCTA (p < 0.001). Vascular attenuation (signal to noise and contrast to noise) of t-MIP were higher than those of sCTA (all, p < 0.001). The collateral status on t-MIP CTA and sCTA were both negatively correlated with modified Rankin Scale scores (t-MIP CTA, r = -0.709, p < 0.001; sCTA, r = -0.551, p = 0.024) and the final infarction volume (t-MIP CTA, r = -0.716, p = 0.001; sCTA, r = -0.629, p = 0.003). t-MIP CTA was better for predicting prognosis (AUC, 0.956; sensitivity, 0.917; specificity, 0.941; p < 0.001) than sCTA (AUC, 0.824; sensitivity, 0.500; specificity, 0.941; p = 0.003).
In comparison with sCTA, t-MIP images showed higher image quality of intracranial vascularity and MIP could reveal vascular occlusion and evaluate collateral circulation more accurately. It was speculated that t-MIP could predict the prognosis more precisely.
描述时间最大密度投影 CTA（t-MIP CTA）在急性缺血性卒中中的应用，并比较 t-MIP CTA 和单相 CTA（sCTA）在评估侧支循环和预测预后方面的差异。
回顾性分析 29 例接受一站式 CT 血管造影（CTA）-CT 灌注扫描的急性缺血性卒中患者。sCTA 和 t-MIP CTA 由 CT 灌注扫描数据生成。比较 sCTA 和 t-MIP CTA 组的图像质量和侧支循环情况。获得并比较两组之间的 CT 衰减值、图像噪声、信噪比、对比噪声比和主观图像质量。分别分析 t-MIP CTA 和 sCTA 上的侧支循环状态与临床预后和梗死体积的相关性。使用受试者工作特征曲线评估 t-MIP CTA 和 sCTA 预测结局的敏感性和特异性。
所有图像均具有良好的诊断质量。在客观评估中，t-MIP CTA 的噪声水平显著低于 sCTA（p<0.001）。t-MIP CTA 的血管衰减（信噪比和对比噪声比）高于 sCTA（均 p<0.001）。t-MIP CTA 和 sCTA 的侧支循环状态均与改良 Rankin 量表评分（t-MIP CTA，r=-0.709，p<0.001；sCTA，r=-0.551，p=0.024）和最终梗死体积（t-MIP CTA，r=-0.716，p=0.001；sCTA，r=-0.629，p=0.003）呈负相关。t-MIP CTA 对预后的预测优于 sCTA（AUC：0.956；敏感性：0.917；特异性：0.941；p<0.001）。
与 sCTA 相比，t-MIP 图像显示颅内血管更高的质量，MIP 可更准确地显示血管闭塞并评估侧支循环。推测 t-MIP 可以更准确地预测预后。
