Application of one-stop CTA + CTP examination in the diagnosis of acute cerebral infarction with cerebral vascular stenosis or occlusion and in the evaluation of cerebral blood perfusion
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摘要:
目的 探究一站式CT血管造影术（CTA）+CT脑灌注成像（CTP）检查在急性脑梗死合并脑血管狭窄或闭塞诊断及脑血流灌注评估中的应用价值。 方法 选择2021年1月~2022年5月共86例急性脑梗死患者作为研究对象，均给予CTA+CTP检查。根据脑血管狭窄程度将其分为轻中度组（中度狭窄、轻度狭窄，n=60）及重度组（脑血管闭塞、重度狭窄，n=26），分析脑血流灌注指标[脑血流量（CBF）、局部血容量（CBV）、平均通过时间（MTT）、达峰时间（TTP）]对脑血管狭窄程度的评估价值；根据侧支循环开放程度将患者分为侧支循环较好组（n=36）及侧支循环不良组（n=21），分析脑血管灌注指标对侧支循环开放程度的评估价值。 结果 86例脑梗死患者脑血管闭塞、重度狭窄、中度狭窄及轻度狭窄发生率分别为10.47%（9/86）、19.77%（17/86）、36.05%（31/86）、33.72%（29/86）；轻中度组及重度组患者患侧CBV及CBF均小于健康侧，TTP、MTT长于健康侧（P < 0.05）；重度组健康侧的CBV、CBF小于轻中度组（P < 0.05）；重度组患侧相比于健康侧CBV、CBF下降值及TTP、MTT增大值大于轻中度组（P < 0.05）；CTP指标联合检测评估脑血管狭窄程度的AUC大于CBV、CBF等指标单独检测（P < 0.05）。侧支循环不良组的CBF高于侧支循环较好组，CBV低于侧支循环较好组，MTT、TTP短于侧支循环较好组（P < 0.05）；CTP指标联合检测评估侧支循环开放程度的AUC值大于各指标单独检测（P < 0.05）。 结论 CTA+CTP检查可急性脑梗死患者脑部血流灌注情况，可用于评估脑血管狭窄程度及侧支循环开放程度。 Abstract:Objective To explore the application value of one-stop CT angiography (CTA) + CT cerebral perfusion imaging (CTP) in the diagnosis of acute cerebral infarction with cerebral vascular stenosis or occlusion and in the evaluation of cerebral blood perfusion. Methods 86 patients with acute cerebral infarction from January 2021 to May 2022 were selected as the research subjects, and all of them were examined by CTA + CTP. According to the degree of cerebral vascular stenosis, the patients were divided into mild-to-moderate group (moderate stenosis, mild stenosis, n=60) and severe group (cerebral vascular occlusion, severe stenosis, n=26). The evaluated value of cerebral blood perfusion indicators [cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP)] on the degree of cerebral vascular stenosis was analyzed. The patients were classified into good collateral circulation group (n=36) and poor collateral circulation group (n=21) according to the degree of collateral circulation, and the evaluated value of cerebral vascular perfusion indicators on opening degree of collateral circulation was analyzed. Results The incidence rates of cerebral vascular occlusion, severe stenosis, moderate stenosis and mild stenosis in 86 patients with cerebral infarction were 10.47% (9/86), 19.77% (17/86), 36.05% (31/86) and 33.72% (29/86) respectively. The CBV and CBF of the affected side of the mild-to-moderate group and severe group were smaller than those of the healthy side, and the TTP and MTT were longer than those of the healthy side (P < 0.05). The CBV and CBF of the healthy side in severe group were smaller than those in mild-to-moderate group (P < 0.05). The decreases of CBV and CBF and the increases of TTP and MTT of the affected side compared with the healthy side were greater in severe group than those in mild-to-moderate group (P < 0.05). The AUC of the combined detection of CTP indicators on evaluating the degree of cerebral vascular stenosis was greater than that of CBV, CBF and other indicators alone (P < 0.05). The CBF in poor collateral circulation group was higher than that in good collateral circulation group while the CBV was lower than that in good collateral circulation group, and MTT and TTP were shorter than those in good collateral circulation group (P < 0.05). The AUC of the combined detection of CTP indicators was greater than that of each indicator alone in evaluating the opening degree of collateral circulation (P < 0.05). Conclusion CTA+CTP can evaluate the cerebral blood perfusion in patients with acute cerebral infarction, and can be used to evaluate the degree of cerebral vascular stenosis and the degree of collateral circulation opening. -
图 1 急性脑梗死的脑血管狭窄或闭塞诊断结果分析
A~C: 男, 72岁, 右侧肢体偏瘫1.5 h, 左侧大脑中动脉供血区超急性期脑梗死, A: CT颅脑平扫图, 未见明显异常; B: CTA VR图, 显示左侧大脑中动脉M2段闭塞, 远端分支减少、变细; C: CTP脑灌注图，显示左侧额颞枕叶低血流灌注. D~F: 男, 65岁, 行走不稳, 右侧视野同向性偏盲2 h, 左侧大脑后动脉供血区超急性期脑梗死, D: CT颅脑平扫图, 未见明显异常; E: CTA VR图，显示左侧大脑后动脉P2段闭塞，远端变细; F: CTP脑灌注图, 显示左侧颞枕叶低血流灌注. G~I: 女, 68岁, 左侧肢体偏瘫4 h, 右侧大脑中动脉供血区超急性期脑梗死, G: CT颅脑平扫图, 未见明显异常; H: CTA VR图, 显示右侧大脑中动脉M1段闭塞, M2段重度狭窄, 远端分支减少; I: CTP脑灌注图, 显示右侧额颞枕叶低血流灌注）.
Figure 1. Analysis of diagnostic results of cerebral vascular stenosis or occlusion in acute cerebral infarction.
图 2 CTP指标评估脑血管狭窄程度的ROC曲线
Figure 2. ROC curve of CTP indicators to evaluate the degree of cerebral vascular stenosis.
图 3 CTP指标对侧支循环情况的评估价值
Figure 3. Evaluated value of CTP indicators on collateral circulation.
表 1 不同狭窄程度患者CTP指标比较
Table 1. Comparison of CTP indicators among patients with different degrees of stenosis (Mean±SD)
指标 轻中度组（n=60） 重度组（n=26） t P CBV[mL/(100 g·min)] 患侧 1.39±0.21 1.15±0.24 4.660 ＜0.001 健康侧 2.05±0.28* 1.91±0.23* 2.241 0.028 差值 0.66±0.12 0.76±0.17 3.113 0.003 CBF（mL/100 g） 患侧 21.91±4.31 17.85±3.72 4.174 ＜0.001 健康侧 27.37±3.15* 25.69±3.98* 2.093 0.039 差值 5.46±1.15 7.84±1.72 7.536 ＜0.001 TTP（s） 患侧 16.85±2.09 18.79±2.13 3.931 ＜0.001 健康侧 14.19±2.11* 14.58±2.06* 0.793 0.430 差值 2.66±0.43 4.21±0.75 12.108 ＜0.001 MTT（s） 患侧 3.62±0.65 3.86±0.51 1.671 0.098 健康侧 3.07±0.43* 2.96±0.38* 1.127 0.263 差值 0.55±0.10 0.90±0.19 11.183 ＜0.001 *P＜0.05 vs患侧. CBF: 脑血流量; CBV: 局部血容量; TTP: 达峰时间; MTT: 平均通过时间. 
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表 2 CTP指标对脑血管狭窄程度的评估价值
Table 2. Evaluated value of CTP indicators on the degree of cerebral vascular stenosis
指标 截点值 AUC SE 95% CI CBV 1.25 mL/（100 g·min） 0.622* 0.075 0.474~0.769 CBF 18.91 mL/100 g 0.685* 0.062 0.564~0.806 TTP 18.06 s 0.790* 0.062 0.669~0.912 MTT 3.71 s 0.613* 0.071 0.473~0.754 联合检测 0.917 0.038 0.843~0.992 *P＜0.05 vs联合检测.
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表 3 侧支循环较好组及侧支循环不良组的病灶侧CTP指标比较
Table 3. Comparison of CTP indicators on the lesion side between good collateral circulation group and poor collateral circulation group
组别 CBF（mL/100g） CBV[mL/(100g·min)] MTT（s） TTP（s） 侧支循环较好组（n=36） 15.67±2.51 1.30±0.28 4.37±0.62 17.91±3.18 侧支循环不良组（n=21） 17.25±3.19 1.13±0.25 3.85±0.69 15.89±3.65 F 2.072 2.297 2.930 2.190 P 0.043 0.025 0.005 0.033
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表 4 CTP指标对侧支循环开放程度的评估价值
Table 4. Evaluated value of CTP indicators on the degree of collateral circulation opening
指标 截点值 AUC SE 95% CI CBV 1.27 mL/（100g·min） 0.712 0.071 0.573~0.850 CBF 16.59 mL/100g 0.652 0.081 0.493~0.811 TTP 16.04 s 0.616 0.077 0.562~0.846 MTT 4.12 s 0.704 0.072 0.465~0.768 联合检测 0.783 0.064 0.658~0.908
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