摘要
目的 探讨全脑CT灌注联合头颈部CTA成像对小体积急性梗死灶诊断准确性及临床预后分析。方法 收集并分析2018年1月~2024年3月在我院接受全脑CT灌注联合头颈CTA成像检查的患者120例,患者均完成全脑CT灌注及MRI检查,以DWI检查结果作为“金标准”,观察并分析CTA、CTP及CTA联合CTP诊断小体积脑梗死的诊断效能,评价指标主要有诊断的敏感度、特异度、阳性预测值、阴性预测值及诊断符合率;根据随访结果对患者进行分组对比,分析CT全脑灌注扫描定量参数差异。结果DWI检查证实小体积脑梗死患者103例,检查结果阴性患者17例;CTA检测阳性患者71例,阴性患者49例;CTP检查阳性患者80例,阴性患者40例;CTA联合CTP联合诊断阳性患者87例,阴性患者33例;以DWI检查结果为金标准,CTA诊断敏感度、特异度、阳性预测值、阴性预测值及诊断符合率分别为41.75%、29.41%、78.18%、7.69%及40.00%,CTP诊断敏感度、特异度、阳性预测值、阴性预测值及诊断符合率分别为71.84%、64.71%、92.50%、27.50%及70.83%,CTA联合CTP诊断敏感度、特异度、阳性预测值、阴性预测值及诊断符合率分别为79.61%、70.59%、94.25%、36.36%及7833%;CTA联合CTP检查的各项指标显著高于CTA、CTP单独结果,差异有统计学意义(P<0.005);103例小体积急性脑梗死患者中,出院三个月后随访行mRS评分,有14例评为0分,36例评为1分,17例评为2分,22例评为3分,9例评为4分,3例评为5分,根据评分结果,67例归入预后良好组,36例归入预后不良组;预后不良组患者年龄明显高于预后良好组(P<0.05),梗死部分分布差异并无统计学意义(P>0.05);预后良好组患者脑梗死体积平均5.63±2.05mL,明显高于预后不良组患者脑梗死体积平均6.71±1.74mL,差异有统计学意义(P<0.05);CTP定量参数显示,小体积急性脑梗死患者预后不良组的CBF和CBV值低于预后良好组,MTT和TTP值高于预后良好组,两组之间差异均有统计学意义(P<0.05)。结论全脑CT灌注联合头颈部CTA成像对小体积急性梗死灶诊断具有一定的诊断价值。
Objective To investigate the diagnostic accuracy and clinical prognosis of whole brain CT perfusion combined with head and neck CTA imaging in small volume acute infarction.Methods A total of 120patients who underwent whole brain CT perfusion combined with head and neck CTA imaging in our hospital from Janua ry 2018 to March 2024 were collected and analyzed.All patients com pleted whole brain CT perfusion and MRI.Taking DWI examination results as the gold standard,the diagnostic efficacy of CTA,CTP and CTA combined with CTP in diagnosing small-volume cerebral infarction was observed and analyzed.The main evaluation indexes were diagnostic sensitivity,specificity,positive predictive value,negative predictive value and diagnostic coincidence rate.According to the followup results,the patients were grouped and compared to analyze the difference of quantitative parameters of CT whole brain perfusion scan.Results DWI examination confirmed 103 patients with small volume cerebral infarction,17 patients with negative results.71 cases were positive and 49 cases were negative by CTA.80 cases were positive and 40 cases were negative by CTP.CTA combined with CTP diagnosed 87 positive patients and 33 negative patients.Ta king DWI as the gold standard,the diagnostic sensitivity,specificity.positive predictive value,negative predictive value and diagnostic coincidence rate of CTA were 41.75%,29.41%,78.18%,7.69%and 40.00%,respectively.Diagnostic sensitivity,specificity,positive predictive value,negative predictive value and diagnostic coincidence rate of CTP were 71.84%,64.71%,92.50%,27.50%and 70.83%,res pectively.The diagnostic sensitivity.specificity,positive predictive value,negative predictive value and diagnostic coincidence rate of CTA combined with CTP were 79.61%,70.59%,94.25%,36.36%and 78.33%,respectively.The indexes of CTA combined with CTP were significantly higher than those of CTA and CTP alone,the difference was statistically significant(P<0.05).Among the 103 patients with small-volume acute cerebral infarction,mRS Scores were performed three months after discharge.14 cases were rated as 0,36as 1,17 as 2,22 as 3,9 as 4,and 3 as 5.According to the scores,67 cases were classified as the good prognosis group and 36 as the poor prognosis group.The age of patients in the poor prognosis group was significantly higher than that in the good prognosis group(P<0.05),and there was no statistical difference in the distribution of infarct parts(P>0.05).The average volu me of cerebral infarction in the good prognosis group was 5.63±2.05mL,which was significantly higher than that in the poor prognosis group(6.71±1.74mL),and the difference was statistically significant(P<0.05).Quantitative parameters of CTP showed that the CBF and CBV values of the poor prognosis group were lower than those of the good prognosis group,and the MTT and TTP values were higher than those of the good prognosis group,with statistical significance between the two groups(P<0.05).Conclusion Whole brain CT perfusion combined with head and neck CTA imaging has certain diagnostic value in the diagnosis of small volume acute infarction.
作者
高燕
吴雯菁
姜亦伦
GAO Yan;WU Wen-jing;JIANG Yi-lun(Department of Imaging,Wuxi Xishan People's Hospital,Wuxi 214000,Jiangsu Province,China)
出处
《中国CT和MRI杂志》
2025年第1期16-18,共3页
Chinese Journal of CT and MRI
基金
江苏省卫生健康委科研项目(Z2019047)。
关键词
全脑CT灌注
CT血管造影
磁共振成像
急性脑梗死
Whole Brain CT Perfusion
CT Angiography
Magnetic Resonance Imaging
Acute Cerebral Infarction
