基于CT灌注成像的侧支评分预测急性前循环大血管闭塞患者动脉取栓治疗预后的价值

目的：评估基于CT灌注成像的软脑膜侧支评价方法（CTP-CS）在预测急性前循环大血管闭塞患者动脉取栓治疗预后中的价值。方法：回顾性分析2013年10月至2016年10月浙江大学医学院附属第二医院急性前循环大血管闭塞动脉取栓患者的临床及影像学资料。采用CTP-CS和基于数字减影血管造影的侧支评分（DSA-CS）对侧支进行评分，DSA-CS或CTP-CS评分3~4分定义为侧支良好。预后优定义为术后3个月时改良Rankin量表（mRS）为2分及以下。采用二元logistic回归法分析侧支循环与患者预后的关系并用受试者工作特征（ROC）曲线评价DSA-CS和CTP-CS在预测患者预后中的价值。结果：共纳入40例患者，其中获得血管再通33例（82.5%），临床预后优16例（40.0%）。与预后不优的患者比较，预后优的患者侧支评分更高（均P<0.05），侧支良好比例更高（均P<0.01）。二元logistic回归分析提示，侧支评分是预后优的独立预测因素（CTP-CS：OR=48.404，95%CI：1.373~1706.585，P<0.05；DSA-CS：OR=34.651，95%CI：1.147~1047.018，P<0.05）。一致性分析提示，CTP-CS和DSA-CS两种评分间的一致性良好（κ=0.697，P<0.01）。ROC曲线分析结果显示，CTP-CS预测患者临床预后的能力与DSA-CS相当（均AUC=0.726，95%CI：0.559~0.893，P<0.05）。结论：CTP-CS评分能独立预测急性前循环大血管闭塞患者动脉取栓治疗的预后。
Abstract: Objective:To evaluate the value of collateral score based on CT perfusion (CTP-CS) in predicting the clinical outcome of patients with anterior circulation ischemic stroke after thrombectomy. Methods:Clinical data of acute ischemic stroke patients with anterior artery occlusion undergoing endovascular treatment in the Second Affiliated Hospital, Zhejiang University School of Medicine during October 2013 and October 2016 were retrospectively reviewed. Collateral scores were assessed based on CTP and digital subtraction angiography (DSA) images, respectively. And DSA-CS or CTP-CS 3-4 was defined as good collateral vessels. Good clinical outcome was defined as a modified Rankin Scale (mRS) ≤ 2 at 3 months after stroke. The binary logistic regression model was used to analyze the correlation between the collateral score and clinical outcome, and the receiver operating characteristic (ROC) curve was used to analyze the value of DSA-CS and CTP-CS in predicting the clinical outcome. Results:Among 40 patients, 33 (82.5%) acquired recanalization and 16 (40.0%) got good outcome. Compared with poor outcome group, the collateral score (all P<0.05) and the rate of good collateral vessels were higher in good outcome group (all P<0.01). After adjust baseline National Institute of Health Stroke Scale (NIHSS) and onset to recanalization time (ORT), good collateral vessels were independent factor of good outcome (CTP-CS:OR=48.404, 95% CI:1.373-1706.585, P<0.05; DSA-CS:OR=34.651, 95% CI:1.147-1047.018, P<0.05). Collateral scores based on CTP and DSA had good consistency (κ=0.697, P<0.01), and ROC curve showed that the predictive value of CTP-CS and DSA-CS were comparable (both AUC=0.726, 95%CI:0.559-0.893, P<0.05). Conclusion:CTP-CS can predict the clinical outcome of patients with anterior circulation ischemic stroke after thrombectomy. Key words: