基于自动化血管密度（RAPID-CTA）的脑卒中患者阳性预测值及脑卒中工作流程结果：一年经验。
Positive predictive value and stroke workflow outcomes using automated vessel density (RAPID-CTA) in stroke patients: One year experience.
机构信息
Department of Radiology, Allegheny Health Network, USA.
Department of Radiology, University of Wisconsin School of Medicine and Public Health, USA.
出版信息
Neuroradiol J. 2021 Oct;34(5):476-481. doi: 10.1177/19714009211012353. Epub 2021 Apr 28.
PURPOSE
Several new techniques have emerged for detecting anterior circulation large vessel occlusion by quantifying relative vessel density including RAPID-CTA, potentially allowing for faster triage and decreased time to mechanical thrombectomy. We present our one-year experience on positive predictive value of RAPID-CTA for the detection of large vessel occlusion in patients presenting with stroke symptoms and its effect on treatment time and clinical outcomes.
MATERIALS AND METHODS
Three hundred and ten patients presenting with stroke symptoms with relative vessel density <60% on RAPID-CTA were included (average age 70 years, 145 male, 165 female). Examinations were considered positive if there was evidence of large vessel occlusion or high grade stenosis. Computed tomography angiography to groin puncture time was calculated during one-year time intervals before and after RAPID-CTA installation. Ninety-day Modified Rankin Scale scores were obtained for patients in each cohort.
RESULTS
Of the 310 patients, 270 had large vessel occlusion or high grade stenosis (87% positive predictive value), with 161 having large vessel occlusion. Using 45% relative vessel density threshold, 129/161 large vessel occlusion were detected (80% sensitivity) and 163/172 examinations were positive (95% positive predictive value). Computed tomography angiography to groin puncture time was significantly lower after deployment of RAPID-CTA (93 min vs 68 min, <0.05). Average 90 day modified Rankin Scale score was lower in the RAPID-CTA group with a higher percentage of patients with functional independence, although the data was not statistically significant.
CONCLUSION
RAPID-CTA had high positive predictive value for large vessel occlusion with a 45% relative vessel density threshold, which could facilitate active worklist reprioritization. Time to treatment was significantly lower and clinical outcomes were improved after deployment of RAPID-CTA.
目的
几种新的技术已经出现，通过量化相对血管密度来检测前循环大血管闭塞，包括 RAPID-CTA，这可能允许更快地分诊和减少机械血栓切除术的时间。我们介绍了我们在一年时间内对 RAPID-CTA 在有卒中症状的患者中检测大血管闭塞的阳性预测值的经验，以及它对治疗时间和临床结果的影响。
材料和方法
纳入了 310 名有卒中症状且 RAPID-CTA 相对血管密度 <60%的患者（平均年龄 70 岁，145 名男性，165 名女性）。如果有大血管闭塞或高级别狭窄的证据，则认为检查为阳性。在 RAPID-CTA 安装前后的一年时间间隔内，计算了从 CT 到腹股沟穿刺的时间。为每个队列的患者获得了 90 天的改良 Rankin 量表评分。
结果
在 310 名患者中，270 名有大血管闭塞或高级别狭窄（87%的阳性预测值），其中 161 名有大血管闭塞。使用 45%的相对血管密度阈值，161 例大血管闭塞中有 129 例（80%的敏感性），172 次检查中有 163 次（95%的阳性预测值）为阳性。在部署 RAPID-CTA 后，CT 到腹股沟穿刺的时间明显缩短（93 分钟对 68 分钟，<0.05）。RAPID-CTA 组的平均 90 天改良 Rankin 量表评分较低，功能独立性的患者比例较高，尽管数据无统计学意义。
结论
RAPID-CTA 在使用 45%的相对血管密度阈值时对大血管闭塞具有高阳性预测值，这可能有助于积极的工作列表重新排序。在部署 RAPID-CTA 后，治疗时间明显缩短，临床结果得到改善。
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