Baraklı Serdar, Yön Mehmet İlker, Ercan Karabekir
Çorum Sungurlu State Hospital, Department of Neurology, Çorum, Turkey.
Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara City Hospital, Department of Neurology, Ankara, Turkey.
Noro Psikiyatr Ars. 2024 Jan 4;62(1):41-47. doi: 10.29399/npa.28643. eCollection 2025.
Unveiling the dynamic penumbra region represents another crucial stage in treating individuals with ischemic strokes. Our objective was to explore how collateral blood flow assessments using multiphasic (triphasic) CT angiography (mpCTA) and CT perfusion (CTP) examinations correlate with the expansion of infarcted areas and disability levels in patients with middle cerebral artery (MCA) M1 and M2 occlusion.
The research was carried out as a prospective, descriptive, case series study. mpCTA and CTP were performed while patients were referred to the emergency department. Baseline National Institutes of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS) and the Barthel Index for Activities of Daily Living at 3 months were calculated. The connection between perfusion parameters that represent penumbral information derived from CTP and collateral flow information obtained from mpCTA with infarct expansion and outcome was investigated.
Thirty-six patients were included in the study. The mean age of the participants in the research was found 73.47±10.67. 52.8% of the individuals were male. 72.3% of the patients exhibited an unfavorable functional outcome according to mRS at 3 months. Based on the Menon collateral score from the mpCTA, the infarct expansion showed a statistically significant difference between the groups (p=0.037). The mRS scores at 3 months did not show a statistically significant difference between the groups according to the mpCTA Menon collateral score (p=0.073). Penumbra volume information obtained by using Tmax/CBV and CBF/CBV thresholds on CTP showed statistically significant differences among good and poor clinical outcome groups based on mRS at 3 months (respectively p=0.010, 0.029). The average MTT value within the penumbra obtained from the MTT/CBV map exhibited a statistically significant difference among the groups based on the mRS at 3 months (p=0.011). There was a weak but statistically significant relationship between the volume of the penumbra obtained from CTP maps created by selecting Tmax=6 sec and the infarct growth (p=0.028).
Final infarct volume and infarct growth can be predicted using collateral circulation data acquired through mpCTA. The patient's disability can be assessed by analyzing the penumbral MTT value and the penumbral volume data obtained from CTP maps generated using various threshold values. Moreover, penumbra volume obtained from CTP maps created by selecting Tmax as a threshold can give information about infarct growth.
揭示动态半暗带区域是治疗缺血性中风患者的另一个关键阶段。我们的目的是探讨使用多期（三期）CT血管造影（mpCTA）和CT灌注（CTP）检查进行的侧支血流评估如何与大脑中动脉（MCA）M1和M2闭塞患者的梗死面积扩大和残疾程度相关。
该研究作为一项前瞻性、描述性病例系列研究开展。在患者被送往急诊科时进行mpCTA和CTP检查。计算基线美国国立卫生研究院卒中量表（NIHSS）、改良Rankin量表（mRS）以及3个月时的日常生活活动Barthel指数。研究了代表CTP衍生的半暗带信息的灌注参数与从mpCTA获得的侧支血流信息与梗死扩展和预后之间的联系。
36名患者纳入研究。研究参与者的平均年龄为73.47±10.67岁。52.8%的个体为男性。根据mRS，72.3%的患者在3个月时功能预后不良。基于mpCTA的梅农侧支评分，梗死扩展在组间显示出统计学显著差异（p=0.037）。根据mpCTA梅农侧支评分，3个月时的mRS评分在组间未显示出统计学显著差异（p=0.073）。使用CTP上的Tmax/CBV和CBF/CBV阈值获得的半暗带体积信息在基于3个月时mRS的良好和不良临床预后组之间显示出统计学显著差异（分别为p=0.010、0.029）。从MTT/CBV图获得的半暗带内平均MTT值在基于3个月时mRS的组间显示出统计学显著差异（p=0.011）。通过选择Tmax = 6秒创建的CTP图获得的半暗带体积与梗死生长之间存在微弱但统计学显著的关系（p=0.028）。
使用通过mpCTA获取的侧支循环数据可以预测最终梗死体积和梗死生长。通过分析半暗带MTT值和从使用各种阈值生成的CTP图获得的半暗带体积数据可以评估患者的残疾情况。此外，通过选择Tmax作为阈值创建的CTP图获得的半暗带体积可以提供有关梗死生长的信息。
