Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Curr Neurovasc Res. 2023;20(1):35-42. doi: 10.2174/1567202620666221230141102.
Branch atheromatous disease (BAD) and lacunar infract (LI) are the different mechanisms of subtypes of acute stroke. We aimed to investigate perfusion deficits and clinical characteristics of the different mechanisms of two subtypes of acute stroke.
Five hundred and ninety-nine CTP examinations were retrospectively reviewed between January and December 2021 in patients with acute stroke symptoms with CTP within 12 hours and MRI within 7 days of symptom onset. Based on diffusion MRI, the patients were assigned to one of two subtypes: BAD and LI. Lesion volumes were measured on NCCT, CTA, CBV, CBF, MTT, and TTP maps by region-of-interest analysis and were confirmed by follow-up MRI.
One hundred thirty-three patients met the inclusion criteria (26.3% female). The BAD group was present in 104 of 133 (78.2%), and the LI group 29 of 133 (21.8%). Based on CT perfusion, 42 of 78 (53.8%) BAD group and 5 of 18 (27.8%) LI group had perfusion deficits in the supratentorial region. BAD had a higher proportion of abnormal perfusion than LI patients, with a significant difference (P < 0.05). The sensitivity of CTP ranged from 21.4% (CBV) to 90.5% (TTP); specificity ranged from 97.2% (TTP) to 100% (CBV, CBF, and MTT) in BAD patients.
CTP has high specificity in identifying BAD. Compromised perfusion deficits are more presented in BAD patients compared with LI. CT perfusion imaging may be useful for determining the clinical significance of perfusion abnormalities in BAD occurrence.
分支粥样硬化性病变（BAD）和腔隙性梗死（LI）是两种急性脑卒中亚型的不同发病机制。本研究旨在探讨两种急性脑卒中亚型不同发病机制的灌注缺损及临床特征。
回顾性分析 2021 年 1 月至 12 月间发病 12 小时内行 CTP 检查、发病 7 天内行 MRI 检查的急性脑卒中症状患者的 599 例 CTP 检查资料。根据弥散 MRI 结果，将患者分为 BAD 和 LI 两型。通过 ROI 分析，在 NCCT、CTA、CBV、CBF、MTT 和 TTP 图上测量病灶体积，并通过随访 MRI 进行验证。
133 例患者符合纳入标准（女性占 26.3%）。133 例患者中，BAD 组 104 例（78.2%），LI 组 29 例（21.8%）。基于 CT 灌注，BAD 组 78 例中有 42 例（53.8%）和 LI 组 18 例中有 5 例（27.8%）存在幕上灌注缺损。BAD 患者的异常灌注比例高于 LI 患者，差异有统计学意义（P<0.05）。CBV 时 CTP 的敏感性为 21.4%（CBV），TTP 时敏感性为 90.5%（TTP）；BAD 患者 TTP 的特异性为 97.2%，CBV、CBF 和 MTT 的特异性为 100%。
CTP 对 BAD 的识别具有较高的特异性。与 LI 患者相比，BAD 患者更易出现灌注缺损。CT 灌注成像有助于确定 BAD 中灌注异常的临床意义。
