摘要
目的探讨CT血管造影(CTA)联合多模态MRI评估急性缺血性脑卒中(AIS)缺血半暗带(IP)和侧枝循环情况及其在预后评估中的价值。方法回顾性收集2019年1月~2022年1月在我院确诊的AIS患者57例,年龄36~78(63.4±12.3)岁,所有患者均行多模态MRI联合CTA检查,收集MRI、CTA资料和临床资料,通过CTA联合3D-TOF-MRA诊断脑侧枝循环和IP,通过组间比较分析影响IP、灌注-扩散不匹配及治疗疗效的影响因素。结果57例患者中,IP 30例(52.6%),无IP 27例(47.4%),IP组糖尿病、高血压和动脉硬化患病比例高于无IP组患者(P<0.05)。侧枝循环分级和入院时梗死区体积及低灌注区体积呈负相关(r=-0.603、-0.331,P<0.01),和灌注-扩散不匹配呈正相关(r=0.528,P<0.001)。侧支循环开放良好组mRS评分≤2分者比例显著高于开放不良组(P<0.05)。疗效显著组的美国国立卫生研究院卒中量表评分改善值、灌注-扩散不匹配、侧枝循环分级优于疗效不显著组(P<0.05)。结论CTA联合多模态MRI有助于评估AIS患者脑组织血流变化情况,侧支循环及IP的准确评估可有效预测AIS的短期疗效。
Objective To explore the value of CT angiography(CTA)combined with multimodal MRI in evaluating the ischemic penumbra(IP)and collateral circulation in acute ischemic stroke(AIS)and its application in prognostic assessment.Methods Fifty-seven cases of AIS patients diagnosed from January 2019 to January 2022 at our hospital were retrospectively collected,with the age of 36-78(63.4±12.3)years old.All patients underwent multimodal MR combined with CTA examination,and the MRI data,CTA data and clinical data were collected.Cerebral collateral circulation and IP were diagnosed through CTA combined with 3D-TOF-MRA.The factors affecting IP,perfusion-diffusion mismatch and therapeutic efficacy were analyzed by intergroup comparison.Results 30 cases(52.6%)in the IP group,and 27 cases(47.4%)in the non-IP group.The difference was statistically significant(P<0.05).The grade of collateral circulation was negatively correlated with the volume of infarct area and hypoperfusion area on admission(r=-0.603,-0.331,P<0.01),and positively correlated with perfusion-diffusion mismatch(r=0.528,P<0.001).There were 37 patients(64.9%)with good collateral circulation and 20 patients(35.1%)with poor patency.The proport(P<0.05).The improved value of NIHSS score,perfusion-diffusion mismatch,and collateral circulation grades in the significant effect group were significantly better than those in the insignificant effect group(P<0.05).Conclusion CTA combined with multimodal MRI is helpful to evaluate the changes of cerebral blood flow in patients with AIS,and the accurate assessment of collateral circulation and IP can effectively predict the short-term curative effect of AIS.
作者
吉廷举
朱雯雯
张力
JI Tingju;ZHU Wenwen;ZHANG Li(Department of Imaging,The First People's Hospital of Lianyungang Guannan campus(The First People's Hospital of Guannan County),Lianyungang 222500,China;Department of General Surgery,The First People's Hospital of Lianyungang City,Lianyungang 222500,China)
出处
《分子影像学杂志》
2024年第5期523-527,共5页
Journal of Molecular Imaging
基金
连云港市同书“521工程”资助项目(LYG06521202230)
连云港市老龄健康科研项目(L202118)
连云港市卫生科技项目(ZD202106)。
关键词
急性缺血性脑卒中
磁共振成像
缺血半暗带
侧枝循环
CT脑血管造影
acute ischemic stroke
magnetic resonance imaging
ischemic penumbra
collateral circulation
CT cerebral angiography
