Department of Imaging, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.
Medical Examination Center, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.
Brain Res Bull. 2023 Oct 15;203:110775. doi: 10.1016/j.brainresbull.2023.110775. Epub 2023 Oct 4.
To investigate the role of spectral CT multiparametric imaging in the evaluation of cerebral microcirculatory perfusion.
The imaging data of 145 patients with asymptomatic cerebral infarction confirmed by MR were retrospectively analyzed, and all cases underwent head CTA and cranial CT perfusion imaging (CTP) on double-layer detector spectral CT. Single energy level images (MonoE45 keV), iodine density maps, and effective atomic number maps were reconstructed based on spectral CTA data, and CT values, iodine density values, and effective atomic number values were measured in the infarcted area, healthy control area, centrum semiovale and posterior limb of the internal capsule, respectively; perfusion values, such as cerebral blood volume (CBV) values, cerebral blood flow (CBF) values, time to peak (TTP) values, and mean passage time, were measured in the above-mentioned areas on CTP images. (TTP) values, and mean time to passage (MTT) values. CT values, iodine density values, effective atomic number values, and perfused CBV, CBF, TTP, and MTT values were compared between the infarcted area and the healthy side, the center of the hemianopia, and the posterior limb of the internal capsule. The role of spectral CT parameters and perfusion parameters in the evaluation of asymptomatic cerebral infarction was analyzed.
CT values, iodine density values, and effective atomic number values were statistically different between the infarcted area and the healthy side; CT values, iodine density values, and effective atomic number values were not statistically different between the infarcted side and the healthy side of the hemispheric centrum and the posterior limb of the internal capsule; CBV and CBF were statistically different between the infarcted side and the healthy side, and MTT and TTP were not statistically different. There were statistically significant differences in TTP between the infarcted area and the healthy side of the hemiaxial center, and no statistically significant differences in CBV, CBF, and MTT. There were no statistical differences in CBV, CBF, TTP, and MTT in the inner capsule area. ROC curve analysis of spectral CT-related parameters and CT perfusion parameters for the diagnosis of asymptomatic cerebral infarction: area under the curve of MonoE 45Kv 0.71, area under the curve of iodine density values 0.76, area under the curve of effective atomic number values 0.74; area under the curve of CBV value 0.64, area under the curve of CBF value 0.61, area under the curve of MTT value 0.50, The area under the TTP curve was 0.52. The area under the ROC curve of the multivariate logistic regression model based on spectral parameters is 0.76, which is higher than that of the logistic regression model with perfusion parameters (P < 0.05).
Spectral CT can better demonstrate small intracranial ischemic lesions, and iodine density values have a better evaluation of microcirculation in asymptomatic cerebral infarcts.
探讨能谱 CT 多参数成像在脑微循环灌注评估中的作用。
回顾性分析 145 例经 MR 证实的无症状性脑梗死患者的影像学资料，所有患者均在双层探测器能谱 CT 上行头 CTA 和颅脑 CT 灌注成像（CTP）检查。基于能谱 CTA 数据重建单能量水平图像（MonoE45keV）、碘密度图和有效原子序数图，分别在梗死区、健侧相应区域、半卵圆中心和内囊后肢测量 CT 值、碘密度值和有效原子序数值；在 CTP 图像上分别测量灌注值如脑血容量（CBV）值、脑血流量（CBF）值、达峰时间（TTP）值和平均通过时间（MTT）值。比较梗死区与健侧、半卵圆中心、内囊后肢 CT 值、碘密度值、有效原子序数值及灌注值 CBV、CBF、TTP、MTT 值的差异。分析能谱参数和灌注参数在无症状性脑梗死评估中的作用。
梗死区与健侧 CT 值、碘密度值、有效原子序数值比较，差异均有统计学意义（P<0.05）；半卵圆中心梗死侧与健侧 CT 值、碘密度值、有效原子序数值比较，差异均无统计学意义（P>0.05）；内囊后肢梗死侧与健侧 CT 值、碘密度值、有效原子序数值比较，差异均无统计学意义（P>0.05）。梗死侧与健侧 CBV 值、CBF 值比较，差异均有统计学意义（P<0.05），MTT 值、TTP 值比较，差异均无统计学意义（P>0.05）。半卵圆中心梗死侧与健侧 TTP 值比较，差异有统计学意义（P<0.05），CBV 值、CBF 值、MTT 值比较，差异均无统计学意义（P>0.05）。内囊后肢区 CBV 值、CBF 值、TTP 值、MTT 值比较，差异均无统计学意义（P>0.05）。能谱 CT 相关参数和 CT 灌注参数对无症状性脑梗死诊断的 ROC 曲线分析：MonoE45Kv 值曲线下面积为 0.71，碘密度值曲线下面积为 0.76，有效原子序数值曲线下面积为 0.74；CBV 值曲线下面积为 0.64，CBF 值曲线下面积为 0.61，MTT 值曲线下面积为 0.50，TTP 值曲线下面积为 0.52。基于能谱参数的多因素逻辑回归模型的 ROC 曲线下面积为 0.76，高于基于灌注参数的逻辑回归模型（P<0.05）。
能谱 CT 可更好地显示颅内小的缺血性病灶，碘密度值对无症状性脑梗死的微循环有更好的评估作用。
