摘要
目的探讨多模式CT定量评估急性缺血性脑卒中(AIS)患者侧支循环、缺血半暗带及核心梗死体积应用价值,以及在静脉溶栓治疗预后的评估价值。方法回顾性分析47例大脑中动脉M1段闭塞的急性缺血性卒中患者的CT灌注成像。使用MIstar软件定量评估缺血半暗带及核心梗死区体积。重建动态4D-CTA,按照ASITN/SIR制定的侧支循环分级系统对AIS患者进行侧支循环量化分级评分。用重复度量检验分析不同侧支循环分级之间美国国立卫生研究院卒中量表(NIHSS)评分的差异,以及与基线缺血半暗带区、核心梗死区体积、最终梗死区体积之间的差异。结果不同侧支循环分级患者在基线、溶栓后1天、1周及1月内NIHSS评分,基线缺血半暗带区、核心梗死区体积、最终梗死区体积差异均有统计学意义(P<0.05)。侧支循环评分3~4级,基线及溶栓后1月内NIHSS评分明显较低。基线缺血半暗带体积越大,最终梗死区体积就越小。结论侧支循环良好的患者,静脉溶栓后最终梗死区体积小、临床预后好。多模式CT定量评估侧支循环及缺血半暗带可更好的预测静脉溶栓的临床预后。
Objective To investigate the value of multimodal CT in the evaluation of the infarct core area,the ischemic penumbra,the collateral circulation and outcome after intravenous thrombolysis in patients with acute ischemic stroke.Methods The CT perfusion imaging with middle cerebral artery of forty-seven patients with acute ischemic stroke were retrospectively analyzed.MIstar software was used to quantitatively evaluate the volume of ischemic penumbra and core infarct.By reconstruction of dynamic CTA,the AIS patients were divided into favorable and unfavorable outcome group according to the improvement of national institutes of health strokescale(NIHSS)score.The differences in national institutes of health stroke scale(NIHSS)scores among different collateral circulation grades were analyzed using the repeat measures test.And the differences with the baseline ischemic penumbra,core infarct volume,and final infarct volume were also analyzed.Results NIHSS scores of patients with different collateral circulation grades at baseline,1 day,1 week and 1 month after thrombolysis showed statistically significant differences in the volume of ischemic penumbra at baseline,core infarction area and final infarction area(P<0.05).For the collateral circulation score grades 3~4,and the NIHSS score was significantly lower at baseline and within 1 month afterthrombolysis.The larger the ischemic penumbra at baseline,the smaller the final infarct.Conclusion In patients with good collateral circulation,the final infarction area after intravenous thrombolysis is small and the clinical prognosis is good.Quantitative evaluation of collateral circulation and ischemic penumbra by multimodal CT can better predict the clinical prognosis of venous thrombolysis.
作者
叶国伟
许兵
邹建勋
鲍丽娟
兰俊
陈旭高
林黎明
YE Guowei;XU Bing;ZOU Jianxun;BAO Lijuan;LAN Jun;CHEN Xugao;LIN Liming(Department of Radiology,The People′s Hospital of Lishui,Zhejiang Province,Lishui 323000,P.R.China;Department of Radiology,Changhai Hospital Affiliated to Naval Military Medical Uiversity,Shanghai 200433,P.R.China)
出处
《医学影像学杂志》
2020年第10期1757-1760,共4页
Journal of Medical Imaging
基金
浙江省医药卫生科技计划项目(编号
2019KY803)
浙江省丽水市人民医院搭梯工程项目(编号:2017CTA016)。
作者简介
叶国伟(1981-),男,浙江云和人,毕业于绍兴文理学院医学院,本科学历,副主任技师,主要从事医学影像技术工作。
