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CTP和多时相CTA预测取栓后临床结果的比较
背景：在接受血管内血栓切除术的急性卒中患者中，CT灌注（CTP）参数与多时项CT血管造影（mCTA）相比的相对预后能力尚不清楚。我们旨在比较mCTA和CTP参数对临床结果的预测准确性。
方法：我们纳入了在墨尔本皇家医院墨尔本脑中心发病后24小时内出现前循环大血管闭塞的急性缺血性中风患者。所有患者均接受CTP及血管内血栓切除术，并使用CTP重建的mCTA图像确定mCTA侧枝评分。主要结果是90天的功能结果，由改良的Rankin量表确定。多变量logistic回归模型分析了mCTA和CTP参数与90天功能结果之间的相关性。使用受试者操作曲线分析和C统计，比较mCTA侧枝评分和CTP参数之间区分90天功能结果的能力。
结果：共纳入120例患者。中位年龄为69岁（四分位范围，60-79），美国国立卫生研究院卒中量表基线得分中位数为14（四分位范围，9-19）。以CTP为基础的相对脑血流量定义的基线缺血核心体积<30%，与良好的功能结果相关（改良Rankin量表评分0-1；优势比0.942[-0.897到-0.989]; 在多变量回归分析中，90天时，P=0.015）和不良功能结果（改良Rankin量表得分5-6；优势比，1.032[1.007-1.056]；P=0.010）。mCTA评分与功能良好（P=0.58）或功能不良（P=0.155）之间无显著相关性。基于相对脑血流量<30%的回归模型最适合90天不良功能结局的数据（C统计，0.834）。
结论：对于接受血管内血栓切除术的急性卒中患者，基于CTP的缺血核心容积比mCTA侧枝评分可以更好地区分90天的功能结果。
Comparison of Computed Tomography Perfusion and Multiphase Computed Tomography Angiogram in Predicting Clinical Outcomes in Endovascular Thrombectomy.
BACKGROUND: In patients with acute stroke who undergo endovascular thrombectomy, the relative prognostic power of computed tomography perfusion (CTP) parameters compared with multiphase CT angiogram (mCTA) is unknown. We aimed to compare the predictive accuracy of mCTA and CTP parameters on clinical outcomes.
METHODS: We included patients with acute ischemic stroke who had anterior circulation large vessel occlusion within 24 hours of onset in Melbourne Brain Centre at the Royal Melbourne Hospital. All patients underwent CTP for endovascular thrombectomy, and the mCTA collateral score was determined using CTP-reconstructed mCTA images. The primary outcome was 90-day functional outcomes defined by modified Rankin Scale. Multivariable logistic regression models analyzed associations between mCTA and CTP parameters and 90-day functional outcomes. The ability to discriminate 90days-functional outcomes was compared between mCTA collateral score and CTP parameters using receiver operating curve analysis and C statistics.
RESULTS: One hundred and twenty patients were included. The median age was 69 years(interquartile range, 60-79), the median baseline National Institutes of Health Stroke Scale score was14 (interquartile range, 9-19). The baseline ischemic core volume, defined by CTP-based relative cerebral blood flow < 30%, was associated with excellent functional outcome (modified Rankin Scale score 0-1; odds ratio, 0.942 [-0.897 to
-0.989]; P =0.015) and poor functional outcome(modified Rankin Scale score 5-6; odds ratio, 1.032[1.007-1.056];P=0.010)at 90 days in the analysis of multivariable regression. There was no significant association between the mCTA score and excellent functional outcome(P=0.58)or poor functional outcome(P=0.155). The relative cerebral blood flow <30%-based regression model best fit the data for the 90-day poor functional outcome (C statistic, 0.834).
CONCLUSIONS: The CTP-based ischemic core volume may provide better discrimination for 90-day functional outcomes for patients with acute stroke undergoing endovascular thrombectomy than the mCTA collateral score.
Stroke; a Journal of Cerebral Circulation 2022 Jun 24;:101161STROKEAHA122038576.
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