| 刘姝姝,陈婷,郭大静,卢建国,陈军.全脑CT灌注联合ABCD3评分预测短暂性脑缺血发作继发脑梗死[J].中国医学影像技术,2022,38(6):831~836 |
| 全脑CT灌注联合ABCD3评分预测短暂性脑缺血发作继发脑梗死 |
| Whole brain CT perfusion combined with ABCD3 score for prediction of brain infarction secondary to transient ischemic attack |
| 投稿时间：2021-09-23 修订日期：2022-02-27 |
| DOI：10.13929/j.issn.1003-3289.2022.06.009 |
| 中文关键词: 脑缺血发作,短暂性 脑梗死 体层摄影术,X线计算机 灌注 血管造影术 |
| 英文关键词:ischemic attack, transient brain infarction tomography, X-ray computed perfusion angiography |
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| 中文摘要: |
| 目的 评价全脑CT灌注（WB-CTP）及联合ABCD3评分预测短暂性脑缺血发作（TIA）患者90天内继发脑梗死的价值。方法 对208例TIA于入院48 h内行WB-CTP检查及ABCD3评分，比较患侧与健侧脑灌注参数差异，分析WB-CTP结果与ABCD3评分的相关性；随访90天，记录脑梗死发生情况，以logistic回归模型分析TIA继发脑梗死的独立因素，评价ABCD3评分、ABCD3评分+WB-CTP及多因素联合预测TIA继发脑梗死的价值。结果 208例中，190例（190/208，91.35%）共230处脑灌注异常，CTP分期Ⅰ期86例（86/190，45.26%）、Ⅱ期104例（104/190，54.74%）；于175例（175/208，84.13%）发现责任血管。患侧脑血流量（CBF）低于健侧（P<0.05）、平均通过时间（MTT）及达峰时间（TTP）均大于健侧（P均<0.05），而两侧脑血容量（CBV）差异无统计学意义（P>0.05）。血管狭窄程度与CTP分期呈正相关（r=0.529，P<0.05）。ABCD3评分与血管狭窄程度、CTP分期及相对MTT （rMTT）均呈正相关（r=0.839、0.556、0.497，P均<0.05），与CBF呈负相关（r=－0.519，P<0.05）。随访90天，65例发生脑梗死，年龄、高血压史、ABCD3评分、血管狭窄程度及CTP分期是TIA患者继发脑梗死的独立影响因素，ABCD3评分、ABCD3评分+WB-CTP、多因素联合模型预测90天内继发性脑梗死的曲线下面积分别为0.847、0.888及0.904，ABCD3评分+WB-CTP、多因素联合模型优于ABCD3评分预测效能（P均<0.05）。结论 WB-CTP联合ABCD3评分可有效预测TIA 90天内继发脑梗死风险。 |
| 英文摘要: |
| Objective To observe the value of whole brain CT perfusion (WB-CTP) combined with ABCD3 score for predicting secondary brain infarction within 90 days in patients with transient ischemic attack (TIA). Methods A total of 208 patients with TIA were prospectively enrolled. WB-CTP examination and ABCD3 scoring were performed within 48 h after admission. Parameters of cerebral perfusion were compared between the affected side and the healthy side, and the correlations of WB-CTP results and ABCD3 scores were analyzed. The patients were followed-up for 90 days since the onset of TIA, and the incidence of cerebral infarction was recorded. Logistic regression model was used to analyze the independent factors of secondary cerebral infarction in TIA patients, and the values of ABCD3 score, ABCD3 score+WB-CTP and combination of multiple factors for predicting secondary brain infarction were evaluated. Results Tatolly 230 abnormal perfusion areas were detected in 190 cases (190/208, 91.35%), including 86 cases (86/190, 45.26%) in CTP stage Ⅰ and 104 cases (104/190, 54.74%) in CTP stage Ⅱ. The responsible vessel was found in 175 cases (175/208, 84.13%). In the affected side, cerebral blood flow (CBF) was lower, the mean transit time (MTT) and time to peak (TTP) were higher than those in the healthy side (all P<0.05), and there was no significant difference of cerebral blood volume (CBV) between 2 sides (P>0.05). The degree of vascular stenosis was positively correlated with CTP stage (r=0.529, P<0.05). ABCD3 score was positively correlated with the degree of vascular stenosis, CTP stage and relative MTT (rMTT) (r=0.839, 0.556, 0.497, all P<0.05), but negatively correlated with CBF (r=-0.519, P<0.05). During the following-up period, cerebral infarction occurred in 65 cases. Age, history of hypertension, ABCD3 score, degree of vascular stenosis and CTP stage were independent impact factors of secondary cerebral infarction in TIA patients. ABCD3 score, ABCD3 score+WB-CTP and combination model of multiple factors was 0.847, 0.888 and 0.904, respectively. ABCD3 score+WB-CTP and combination model of multiple factors were superior to ABCD3 score for predicting secondary cerebral infarction within 90 days of TIA (both P<0.05). Conclusion WB-CTP combined with ABCD3 score could effectively predict the risk of secondary cerebral infarction within 90 days of TIA. |
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