TCD联合mCTA及CTP对前循环大动脉粥样硬化型急性缺血性脑卒中近期预后的评估

The evaluation of the short-term prognosis of large artery atherosclerotic anterior circulation AIS by TCD combined with mCTA and CTP

摘要:

目的 探究经颅多普勒超声（TCD）联合多时相CT血管成像（mCTA）及CT灌注成像（CTP）对前循环大动脉粥样硬化型急性缺血性脑卒中（AIS）颅内侧支循环及近期预后的评估价值。方法 选取2024年7月—2025年5月安徽医科大学第三附属医院收治的94例发病时间距住院时间<72 h的前循环大动脉粥样硬化型AIS患者为研究对象。入院后均行TCD、mCTA及CTP检查，根据基于mCTA的Alberta卒中项目早期CT评分（ASPECTS）将患者分为侧支良好组与侧支不良组。分析侧支循环评分与CTP、TCD的相关性。通过电话随访患者90 d预后，根据改良Rankin评分（mRS）将患者分为预后良好组（62例）与预后不良组（32例）。采用多因素一般Logistics回归模型分析90 d预后的独立影响因素，绘制受试者工作特征（ROC）曲线分析各因子的预测效能。结果 94例患者中侧支良好组64例（68.09%），侧支不良组30例（31.91%）；侧支循环评分与局部脑血流量（rCBF）、局部脑血容量（rCBV）、搏动指数（PI）与平均血流速度（Vm）均呈正相关（P <0.05），与局部平均通过时间（rMTT）、局部达峰时间（rTTP）均呈负相关（P <0.05）；预后不良组合并高血压比例、合并糖尿病比例、合并卒中史比例、NIHSS评分、rTTP均高于预后良好组（P <0.05），ASPECTS评分、rCBF、PI、Vm均低于预后不良组（P <0.05）；rCBF、Vm为预后的独立保护因素（P <0.05），rTTP为预后的独立危险因素（P <0.05）；rCBF、TTP、Vm联合检测的敏感性和特异性高于其中任何一个参数的单一检测。结论 mCTA可直接评估患者侧支循环等级，CTP、TCD可通过灌注参数间接反映侧支循环状态，在预测评估患者近期预后方面，以上检查均有参考价值且联合检测效能最佳。

Abstract:

Objective To explore the value of transcranial Doppler (TCD) combined with multiphase CT angiography (mCTA) and CT perfusion imaging (CTP) in assessing intracranial collateral circulation and short-term prognosis in patients with large artery atherosclerotic anterior circulation acute ischemic stroke (AIS).Methods A total of 94 patients with large artery atherosclerotic anterior circulation AIS, whose onset time was less than 72 hours before hospitalization, admitted to the Third Affiliated Hospital of Anhui Medical University from July 2024 to May 2025 were selected as the research subjects. All patients underwent TCD, mCTA and CTP examinations after admission. According to the Alberta Stroke Program Early CT Score (ASPECTS) based on mCTA, the patients were divided into a good collateral group and a poor collateral group. The correlation between collateral circulation score and CTP and TCD parameters was analyzed. The 90-day prognosis of patients was assessed by telephone follow-up. According to the modified Rankin Scale (mRS) score, the patients were divided into a good prognosis group (62 cases) and a poor prognosis group (32 cases). Multivariate general Logistic regression model was used to analyze the independent influencing factors of 90-day prognosis, and receiver operating characteristic (ROC) curve was plotted to analyze the predictive efficacy of each factor.Results Among the 94 patients, 64 cases (68.09%) were in the good collateral group and 30 cases (31.91%) were in the poor collateral group. The collateral circulation score was positively correlated with regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), pulsatility index (PI) and mean blood flow velocity (Vm) (all P < 0.05), and negatively correlated with regional mean transit time (rMTT) and regional time to peak (rTTP) (all P < 0.05). The proportion of complicated hypertension, complicated diabetes mellitus, complicated stroke history, National Institutes of Health Stroke Scale (NIHSS) score and rTTP in the poor prognosis group were significantly higher than those in the good prognosis group (all P < 0.05), while the ASPECTS score, rCBF, PI and Vm were significantly lower than those in the good prognosis group (all P < 0.05). rCBF and Vm were independent protective factors for prognosis (all P < 0.05), and rTTP was an independent risk factor for prognosis (P < 0.05). The sensitivity and specificity of the combined detection of rCBF, rTTP and Vm were higher than those of the single detection of any one of these parameters.Conclusion mCTA can directly assess the grade of collateral circulation in patients, while CTP and TCD can indirectly reflect the status of collateral circulation through perfusion parameters. For predicting and evaluating the short-term prognosis of patients, all the above examinations have reference value, and the combined detection has the best efficacy.