Li Chanchan, Hao Xiaozhu, Lin Luyi, Sun Chengfeng, Yu Hai, Yao Zhenwei, Feng Xiaoyuan, Yang Yanmei
Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
Front Aging Neurosci. 2021 Aug 25;13:703734. doi: 10.3389/fnagi.2021.703734. eCollection 2021.
Multimodal CT, including CT angiography (CTA) and CT perfusion (CTP), was increasingly used in stroke triage. This study was to determine the relationship between a new integrated parameter-both collateral circulation and relative permeability surface (PS)-and the hemorrhagic transformation (HT) in acute ischemic stroke (AIS) with middle cerebral artery occlusion (MCAO).
We retrospectively reviewed consecutive AIS patients with MCAO who underwent baseline CTA/CTP within 4 h of symptom onset and follow-up susceptibility-weighted imaging (SWI) within 3 weeks. Collateral circulation was assessed on the baseline CTA. Baseline CTP data were postprocessed to generate PS parameter. The patients with poor collateral circulation and at the same time with high relative PS were classified as the group of both poor collateral circulation and high relative PS. HT was defined according to European Cooperative Acute Stroke Study II criteria on follow-up SWI imaging. Multivariate logistic regression analysis was performed using HT as an outcome variable.
The group of patients with both poor collateral circulation and high relative PS was thirteen and thirty-three (52%) developed HT of the final cohort sixty-three AIS patients with MCAO. Multivariate logistic analysis revealed the new integrated parameter-both collateral circulation and relative PS (odds ratio, 16.59; 95% confidence interval, 13.09-19.10; < 0.001) was independent predictor of HT. The area under the curve was 0.85 (95% confidence interval, 0.81-0.89). The sensitivity was 57%, specificity 97% and positive predictive value 92%, negative predictive value 58%.
For AIS patients with MCAO, these with poor collateral circulation on CTA and at the same time with high relative PS on CTP were at high risk for HT.
包括CT血管造影（CTA）和CT灌注（CTP）在内的多模态CT在卒中分诊中的应用越来越广泛。本研究旨在确定一个新的综合参数——侧支循环和相对通透表面积（PS）——与大脑中动脉闭塞（MCAO）的急性缺血性卒中（AIS）患者出血性转化（HT）之间的关系。
我们回顾性分析了连续的MCAO所致AIS患者，这些患者在症状发作4小时内接受了基线CTA/CTP检查，并在3周内接受了随访磁敏感加权成像（SWI）。在基线CTA上评估侧支循环。对基线CTP数据进行后处理以生成PS参数。侧支循环差且相对PS高的患者被归类为侧支循环差且相对PS高的组。根据欧洲急性卒中协作研究II标准在随访SWI成像上定义HT。以HT作为结局变量进行多因素逻辑回归分析。
在最终纳入的63例MCAO所致AIS患者队列中，侧支循环差且相对PS高的患者组有13例，其中33例（52%）发生了HT。多因素逻辑分析显示，新的综合参数——侧支循环和相对PS（比值比，16.59；95%置信区间，13.09 - 19.10；P < 0.001）是HT的独立预测因素。曲线下面积为0.85（95%置信区间，0.81 - 0.89）。敏感性为57%，特异性为97%，阳性预测值为92%，阴性预测值为58%。
对于MCAO所致AIS患者，CTA显示侧支循环差且CTP显示相对PS高的患者发生HT的风险较高。
