CT脑灌注成像联合经颅多普勒超声对急性脑梗死侧支循环及溶栓效果有预测价值

胡海涛.CT脑灌注成像联合经颅多普勒超声对急性脑梗死侧支循环及溶栓效果有预测价值[J].内科急危重症杂志,2025,31(3):226-230

DOI：10.11768/nkjwzzzz20250306

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基金项目:

作者	单位	E-mail
胡海涛	苏州大学附属苏州九院影像科	jiyiding2020@126.com

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中文摘要:

摘要目的：探讨CT脑灌注成像联合超声检查在急性脑梗死（ACI）侧支循环评估及溶栓疗效预测中的应用价值。方法：回顾性分析接受溶栓治疗的92例ACI患者临床资料，所有患者在溶栓后24h进行数字减影血管造影（DSA）、CT脑灌注成像及经颅多普勒超声（TCD）检查。根据DSA结果分为侧支循环不良组（83例）和侧支循环良好组（9例），再根据溶栓效果分为有效组（58例）和无效组（34例），评价CT脑灌注成像、TCD对ACI患者侧支循环及溶栓疗效的预测价值。结果：以DSA结果为金标准，CT脑灌注成像检查评估侧支循环不良的准确率较TCD检查的准确率更高（85.87% vs 70.65%,P< 0.05），且二者联合评估的准确率（98.91%）较单项检查更高(P< 0.05),二者联合检查与DSA结果的一致性更高（Kappa值=0.941）。经溶栓治疗7d后，92例ACI患者58例有效，其中侧支循环良好组的溶栓有效率明显高于侧支循环不良组（P＜0.05）。有效组的脑血容量（CBV）、强化峰值（PE）、平均血流速度（Vm）高于无效组，血流搏动指数（PI）低于无效组（P均＜0.05）。受试者工作特征（ROC）曲线分析显示，CBV、PE、PI、Vm对ACI患者溶栓效果有预测效能（P均＜0.05），其中PE的诊断效能最高，约登指数最大时截断值为6.683 Hu，曲线下面积为0.827，敏感度为65.52%，特异性为91.18%，但四项指标联合预测的效能更高，曲线下面积为0.913，敏感度为70.69%，特异性为97.06%。结论：CT脑灌注成像联合TCD检查在ACI患者侧支循环评估及溶栓疗效预测中有应用价值。

英文摘要:

Abstract Objective: To explore the application value of CT cerebral perfusion imaging combined with ultrasound examination on the evaluation of collateral circulation and the prediction of thrombolytic efficacy in acute cerebral infarction (ACI). Methods: The clinical data of 92 patients with ACI who received thrombolytic therapy were retrospectively analyzed. All the above patients received digital subtraction angiography (DSA), CT cerebral perfusion imaging and transcranial Doppler ultrasound (TCD) at 24 h after thrombolysis. According to DSA examination results, the patients were divided into poor collateral circulation group (83 cases) and good collateral circulation group (9 cases). By means of thrombolytic effect, they were divided into effective group (58 cases) and ineffective group (34 cases). The predictive value of CT cerebral perfusion imaging and TCD on collateral circulation and thrombolytic efficacy of patients with ACI was evaluated. Results: Taking DSA result as the gold standard, the accuracy rate of CT cerebral perfusion imaging in assessing collateral circulation was higher than that of TCD (85.87% vs 70.65%, P< 0.05), and the accuracy rate of the combination of the two examination methods (98.91%) was higher than that of the two alone, and the consistency with the DSA result was better (Kappa=0.941). After 7 days of thrombolysis, 58 of 92 patients with ACI were effective, and the effective rate of thrombolysis in good collateral circulation group was significantly higher than that in poor collateral circulation group (P< 0.05). The cerebral blood volume (CBV), peak enhancement (PE) and mean blood flow velocity (Vm) in effective group were higher than those in ineffective group while the PI was lower than that in ineffective group (all P< 0.05). Receiver operating characteristic (ROC) curve analysis showed that the CBV, PE, PI and Vm had predictive efficiency on thrombolytic effect in patients with ACI (all P< 0.05), and PE had the highest diagnostic efficiency, and when its Youden index was the largest, the corresponding cut-off value, area under the curve, sensitivity and specificity were 6.683 Hu, 0.827, 65.52% and 91.18%, respectively. However, the combined prediction of the four indicators had higher efficiency, with area under the curve of 0.913, sensitivity of 70.69% and specificity of 97.06%. Conclusion: CT cerebral perfusion imaging combined with TCD has significant application value in evaluating collateral circulation and the prediction of thrombolytic efficacy in patients with ACI.