使用静脉期CT上的阿尔伯塔卒中项目早期CT评分预测血管内血栓切除术治疗后急性缺血性卒中患者的最终梗死体积和临床结局。
Predicting final infarct size and clinical outcomes in patients with acute ischemic stroke after endovascular thrombectomy using the Alberta Stroke Program early CT score on venous-phase CT.
作者信息
Yin Zi-Xin, Shen Guang-Chen, Ni Wen-Jing, Lu Shan-Shan, Liu Sheng, Shi Hai-Bin, Xu Xiao-Quan, Wu Fei-Yun
机构信息
Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China.
Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China.
出版信息
Acta Radiol. 2025 Jan;66(1):42-49. doi: 10.1177/02841851241291928. Epub 2024 Nov 18.
BACKGROUND
The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is a semi-quantitative tool for evaluating the extent and distribution of early ischemic changes.
PURPOSE
To assess the value of ASPECTS on non-contrast CT (NCCT), arterial-phase CT (APCT), or venous-phase CT (VPCT) in predicting the final infarct core (IC) on follow-up diffusion-weighted imaging (DWI) and the clinical outcomes of patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT).
MATERIAL AND METHODS
In total, 120 patients with AIS who underwent EVT in our center were retrospectively enrolled. Correlations between CT-ASPECTS and follow-up DWI-ASPECTS were analyzed using Spearman's rank correlation coefficient. Mean differences and limit of agreement (LoA) between CT-ASPECTS and follow-up DWI-ASPECTS were assessed using the Bland-Altman plots. Multivariate logistic regression and receiver operating characteristic curve analyses were used to identify independent factors and evaluate their performances in predicting the clinical outcomes.
RESULTS
VPCT-ASPECTS exhibited the highest correlation with follow-up DWI-ASPECTS (r = 0.846, < 0.001), followed by APCT-ASPECTS (r = 0.613, < 0.001) and NCCT-ASPECTS (r = 0.557, < 0.001). The mean difference between VPCT-ASPECTS and follow-up DWI-ASPECTS was 0.0 (limit of agreement = -2.1 to 2.1). National Institute of Health Stroke Scale (NIHSS) scores at admission (NIHSS) (odds ratio [OR]=1.162, 95% confidence interval [CI]=1.063-1.270; = 0.001) and VPCT-ASPECTS (OR=0.728, 95% CI=0.535-0.991; = 0.044) were the independent factors associated with clinical outcomes. The combined model integrating NIHSS and VPCT-ASPECTS exhibited an excellent performance in predicting good clinical outcomes (area under curve [AUC]=0.807; sensitivity=75.0%; specificity=72.3%).
CONCLUSION
VPCT-ASPECTS may be a promising imaging biomarker to predict the final IC and the clinical outcome of the patients with AIS after EVT.
背景
阿尔伯塔卒中项目早期计算机断层扫描评分（ASPECTS）是一种用于评估早期缺血性改变范围和分布的半定量工具。
目的
评估非增强CT（NCCT）、动脉期CT（APCT）或静脉期CT（VPCT）上的ASPECTS在预测随访扩散加权成像（DWI）上的最终梗死核心（IC）以及血管内血栓切除术（EVT）后急性缺血性卒中（AIS）患者临床结局方面的价值。
材料与方法
本研究回顾性纳入了在本中心接受EVT的120例AIS患者。使用Spearman等级相关系数分析CT-ASPECTS与随访DWI-ASPECTS之间的相关性。使用Bland-Altman图评估CT-ASPECTS与随访DWI-ASPECTS之间的平均差异和一致性界限（LoA）。采用多因素逻辑回归和受试者工作特征曲线分析来确定独立因素并评估它们在预测临床结局方面的表现。
结果
VPCT-ASPECTS与随访DWI-ASPECTS的相关性最高（r = 0.846，<0.），其次是APCT-ASPECTS（r = 0.613，<0.）和NCCT-ASPECTS（r = 0.557，<0.）。VPCT-ASPECTS与随访DWI-ASPECTS之间的平均差异为0.0（一致性界限=-2.1至2.1）。入院时的美国国立卫生研究院卒中量表（NIHSS）评分（优势比[OR]=1.162，95%置信区间[CI]=1.063 - 1.270；=0.）和VPCT-ASPECTS（OR=0.728，95%CI=0.535 - 0.991；=0.044）是与临床结局相关的独立因素。整合NIHSS和VPCT-ASPECTS的联合模型在预测良好临床结局方面表现出色（曲线下面积[AUC]=0.807；敏感性=75.0%；特异性=72.3%）。
结论
VPCT-ASPECTS可能是一种有前景的影像学生物标志物，可用于预测EVT后AIS患者的最终IC和临床结局。
Zotero 插件