全脑CT灌注联合ABCD3评分对短暂性脑缺血发作后短期继发性脑梗死的预测价值
Predictive value of whole-brain CT perfusion combined with ABCD3 score for short-term secondary cerebral infarction after TIA.
作者信息
Liu Shushu, Chen Ting, Wu Wei
机构信息
Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Medical Imaging, People's Hospital of Fengjie, Chongqing, China.
出版信息
Front Neurol. 2023 Sep 7;14:1244014. doi: 10.3389/fneur.2023.1244014. eCollection 2023.
OBJECTIVE
To investigate the predictive value of Whole Brain CT Perfusion (WB-CTP) combined with the ABCD3 score in patients with transient ischemic attack (TIA).
METHODS
A total of 336 TIA patients with TIA underwent WB-CTP and ABCD3 score assessment within 48 h of admission. Spearman correlation test was performed to analyze the relationship between the degree of vascular stenosis, relative perfusion values, and ABCD3 score. Logistic regression analysis was used to identify independent risk factors for secondary cerebral infarction. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive value of relative cerebral blood flow (rCBF), degree of vascular stenosis, ABCD3 score, and the WB-CTP-ABCD3 combined model for secondary cerebral infarction after TIA. Calibration curves and H-L tests were used to evaluate the predictive efficacy of the model.
RESULTS
Among the 336 TIA patients, 143 showed abnormal perfusion areas and 146 had responsible vessel stenosis. The degree of vascular stenosis, relative time-to-maximum (rTmax), and relative mean transit time (rMTT) were positively correlated with the ABCD3 score, while rCBF and relative cerebral blood volume (rCBV) were negatively correlated with the ABCD3 score. ROC curve analysis identified a cutoff value of 0.8205 for rCBF, with a sensitivity of 84.10% and specificity of 58.10% for distinguishing the cerebral infarction group from the non-cerebral infarction group. Furthermore, rCBF ≤ 0.8205, degree of vascular stenosis, and ABCD3 score > 6 were identified as independent risk factors for secondary cerebral infarction in TIA patients within 90 days in TIA patients. The AUC of the WB-CTP-ABCD3 combined model for predicting secondary cerebral infarction within 90 days was 0.836. The model risk was assessed by plotting calibration curves. The value of p for the H-L goodness of fit test was 0.366 ( > 0.05), which indicated that the difference between the obtained model and the perfect model were statistically insignificant.
CONCLUSION
The combined model of WB-CTP-ABCD3 shows promise as a valuable method for predicting secondary cerebral infarction within 90 days following TIA.
目的
探讨全脑CT灌注（WB-CTP）联合ABCD3评分对短暂性脑缺血发作（TIA）患者的预测价值。
方法
共纳入336例TIA患者，于入院48小时内进行WB-CTP及ABCD3评分评估。采用Spearman相关性检验分析血管狭窄程度、相对灌注值与ABCD3评分之间的关系。运用Logistic回归分析确定继发脑梗死的独立危险因素。绘制受试者工作特征（ROC）曲线，评估相对脑血流量（rCBF）、血管狭窄程度、ABCD3评分及WB-CTP-ABCD3联合模型对TIA后继发脑梗死的预测价值。采用校准曲线和H-L检验评估模型的预测效能。
结果
336例TIA患者中，143例存在灌注异常区域，146例存在责任血管狭窄。血管狭窄程度、相对达峰时间（rTmax）及相对平均通过时间（rMTT）与ABCD3评分呈正相关，而rCBF及相对脑血容量（rCBV）与ABCD3评分呈负相关。ROC曲线分析显示，rCBF区分脑梗死组与非脑梗死组的截断值为0.8205，灵敏度为84.10%，特异度为58.10%。此外，rCBF≤0.8205、血管狭窄程度及ABCD3评分>6被确定为TIA患者90天内继发脑梗死的独立危险因素。WB-CTP-ABCD3联合模型预测90天内继发脑梗死的AUC为0.836。通过绘制校准曲线评估模型风险。H-L拟合优度检验的p值为0.366（>0.05），表明所得模型与理想模型之间的差异无统计学意义。
结论
WB-CTP-ABCD3联合模型有望成为预测TIA后90天内继发脑梗死的有价值方法。
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