基于 CT 灌注的 rCBF <38% 容积与前循环大血管闭塞中的数字减影血管造影侧支评分呈独立负相关。
CT perfusion based rCBF <38% volume is independently and negatively associated with digital subtraction angiography collateral score in anterior circulation large vessel occlusions.
机构信息
Department of Radiology and Radiological Sciences, Johns Hopkins University, USA.
Department of Biostatistics, West Virginia University, USA.
出版信息
Neuroradiol J. 2024 Aug;37(4):462-467. doi: 10.1177/19714009241242639. Epub 2024 Mar 25.
BACKGROUND
Collateral status (CS) is an important biomarker of functional outcomes in patients with acute ischemic stroke secondary to large vessel occlusion (AIS-LVO). Pretreatment CT perfusion (CTP) parameters serve as reliable surrogates of collateral status (CS). In this study, we aim to assess the relationship between the relative cerebral blood flow less than 38% (rCBF <38%), with the reference standard American Society of Interventional and Therapeutic Neuroradiology (ASITN) collateral score (CS) on DSA.
METHODS
In this prospectively collected, retrospectively reviewed analysis, inclusion criteria were as follows: (a) CT angiography (CTA) confirmed anterior circulation large vessel occlusion from 9/1/2017 to 10/01/2023; (b) diagnostic CT perfusion; and (c) underwent mechanical thrombectomy with documented ASITN CS. The ratios of the CTP-derived CBF values were calculated by dividing the values of the ischemic lesion by the corresponding values of the contralateral normal region (which were defined as rCBF). Spearman's rank correlation and logistic regression analysis were performed to determine the relationship of rCBF <38% lesion volume with DSA ASITN CS. ≤ .05 was considered significant.
RESULTS
In total, 223 patients [mean age: 67.77 ± 15.76 years, 56.1% ( = 125) female] met our inclusion criteria. Significant negative correlation was noted between rCBF <38% volume and DSA CS (ρ = -0.37, < .001). On multivariate logistic regression analysis, rCBF <38% volume was found to be independently associated with worse ASITN CS (unadjusted OR: 3.03, 95% CI: 1.60-5.69, < .001, and adjusted OR: 2.73, 95% CI: 1.34-5.50, < .01).
CONCLUSION
Greater volume of tissue with rCBF <38% is independently associated with better DSA CS. rCBF <38% is a useful adjunct tool in collateralization-based prognostication. Future studies are needed to expand our understanding of the role of rCBF <38% within the decision-making in patients with AIS-LVO.
背景
侧支状态（CS）是大血管闭塞（AIS-LVO）后急性缺血性卒中患者功能结局的重要生物标志物。预处理 CT 灌注（CTP）参数可作为侧支状态（CS）的可靠替代指标。在这项研究中，我们旨在评估相对脑血流量小于 38%（rCBF<38%）与 DSA 美国介入治疗和神经放射学学会（ASITN）侧支评分（CS）参考标准之间的关系。
方法
本研究为前瞻性收集、回顾性分析，纳入标准如下：（a）CT 血管造影（CTA）证实 9/1/2017 至 10/01/2023 期间前循环大血管闭塞；（b）诊断性 CT 灌注；（c）行机械血栓切除术，并记录 ASITN CS。通过将缺血性病变的值除以对侧正常区域的值（定义为 rCBF）计算 CTP 衍生 CBF 值的比值。采用 Spearman 秩相关和逻辑回归分析确定 rCBF<38%病变体积与 DSA ASITN CS 的关系。 <.05 被认为具有统计学意义。
结果
共有 223 名患者（平均年龄：67.77±15.76 岁，56.1%[=125]为女性）符合纳入标准。rCBF<38%病变体积与 DSA CS 之间存在显著负相关（ρ=-0.37， <.001）。多元逻辑回归分析发现，rCBF<38%病变体积与 ASITN CS 较差独立相关（未校正 OR：3.03，95%CI：1.60-5.69， <.001，校正 OR：2.73，95%CI：1.34-5.50， <.01）。
结论
rCBF<38%病变体积越大，与 DSA CS 越好独立相关。rCBF<38%是侧支代偿预测的有用辅助工具。需要进一步研究以扩大我们对 rCBF<38%在 AIS-LVO 患者决策中的作用的理解。
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