Zhang Wei-Yong, Xiang Shi-Feng, Yang Su-Jun, Wu Yi-Ping, Li Jun-Tao, Liu Guo-Kun, Li Jian-Fei, Wang Wei-Wei
Department of CT/MRI, Handan Central Hospital, Handan, 056001, People's Republic of China.
Department of Neurology, Handan Central Hospital, Handan, 056001, People's Republic of China.
Int J Gen Med. 2021 May 17;14:1865-1871. doi: 10.2147/IJGM.S309232. eCollection 2021.
The present study investigated the predictive value of each perfusion parameter of the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) in CT perfusion (CTP) imaging for the prognosis of endovascular treatment at the time of admission in patients with acute ischemic stroke in the anterior circulation.
The imaging data of 62 patients with acute ischemic stroke in the anterior circulation with an onset time of 6 h or less were retrospectively analyzed. All patients underwent the one-stop whole-brain dynamic volume four-dimensional (4D) CT angiography (CTA)-CTP and cranial magnetic resonance imaging (MRI) within seven days after treatment. The patients were divided into better and worse prognosis groups according to their clinical symptoms, combined with an MRI-ASPECTS score of ≤ 6 within seven days after treatment. The observed perfusion parameters included cerebral blood flow (CBF)-ASPECTS, cerebral blood volume (CBV)-ASPECTS, mean transit time (MTT)-ASPECTS, and time to peak (TTP)-ASPECTS. The difference in ASPECTS scores involving the CTP parameter, as well as diagnostic power, was compared between the two groups of patients.
All CTP-ASPECTS scores negatively correlated with clinical prognosis. The higher the CTP-ASPECTS scores preceding treatment in patients with ischemic stroke in the anterior circulation, the better the prognosis. There were statistically significant differences in the scores of CBF-ASPECTS and CBV-ASPECTS between the two groups (P < 0.05). Receiver operating curve (ROC) analysis showed that the parameter with the largest area under the curve (AUC) was the CBF-ASPECTS score (P = 0.003), with a sensitivity of 90.9%, a specificity of 59.1%, and an AUC of 0.806, which was the most valuable prognostic predictor.
The CBF-ASPECTS score presented significant value as a primary indicator for predicting the outcome of endovascular treatment in patients with acute ischemic stroke in the anterior circulation, and it had good application prospects in clinical practice.
本研究探讨了阿尔伯塔卒中项目早期计算机断层扫描评分（ASPECTS）的各灌注参数在CT灌注（CTP）成像中对前循环急性缺血性卒中患者入院时血管内治疗预后的预测价值。
回顾性分析62例前循环急性缺血性卒中且发病时间在6小时及以内的患者的影像资料。所有患者在治疗后7天内接受一站式全脑动态容积四维（4D）CT血管造影（CTA）-CTP及头颅磁共振成像（MRI）检查。根据患者临床症状，并结合治疗后7天内MRI-ASPECTS评分≤6分，将患者分为预后较好组和预后较差组。观察的灌注参数包括脑血流量（CBF）-ASPECTS、脑血容量（CBV）-ASPECTS、平均通过时间（MTT）-ASPECTS和达峰时间（TTP）-ASPECTS。比较两组患者涉及CTP参数的ASPECTS评分差异及诊断效能。
所有CTP-ASPECTS评分均与临床预后呈负相关。前循环缺血性卒中患者治疗前CTP-ASPECTS评分越高，预后越好。两组间CBF-ASPECTS和CBV-ASPECTS评分差异有统计学意义（P<0.05）。受试者工作特征曲线（ROC）分析显示，曲线下面积（AUC）最大的参数为CBF-ASPECTS评分（P = 0.003），敏感性为9成，特异性为59.1%，AUC为0.806，是最有价值的预后预测指标。
CBF-ASPECTS评分作为预测前循环急性缺血性卒中患者血管内治疗结局的主要指标具有重要价值，在临床实践中有良好的应用前景。
