| Research objective:1.To explore the application value of quantitative CT perfusion imaging(qCTPI)in evaluating hemorrhagic transformation(HT)of AIS,and to determine the threshold of CT perfusion parameters for predicting hemorrhagic transformation of AIS,so as to provide imaging basis for clinical treatment decision-making and prognosis evaluation.2.To explore the correlation between CT quantitative perfusion parameters and clinical NIHSS score,and to clarify whether CT quantitative parameters can reflect the degree of brain function damage in AIS patients,so as to provide quantitative imaging indicators for clinical evaluation of disease severity and prognosis.Materials and Methods:1.The CTPI data of 43 patients with acute ischemic cerebral infarction were retrospectively analyzed.Inclusion criteria:1)Complying with the diagnostic criteria in the guidelines for the diagnosis and treatment of acute ischemic stroke issued by the Chinese Medical Association in 2014;2)Excluding intracranial hemorrhage by the first brain CT examination;3)Not receiving intravenous thrombolysis or vascular interventional therapy;4)Within 2 weeks of onset of cerebral infarction,HT was confirmed by CT or MR examination.Exclusion criteria:1)Thrombolytic therapy;2)Arterial malformations,aneurysms and other diseases;3)Previous history of intracranial hemorrhage and traumatic brain injury;4)Severe heart,lung,liver and kidney dysfunction;5)Incomplete imaging data.According to whether hemorrhagic transformation(HT)occurs within 2 weeks of onset of cerebral infarction by CT or magnetic resonance(MR),the patients were divided into HT group(n=20)and control group(n=23).Mann-Whitney U test was used to compare the differences of CT perfusion parameters(surface permeability Surface(PS),cerebral blood flow(CBF)and cerebral blood volume(CBV)between the affected and contralateral sides of HT group and between the affected and control sides of HT group.The ROC curve was used to analyze the efficiency of PS value to predict HT.2.Of the 43 patients with acute ischemic cerebral infarction mentioned above,34 patients had CTP examination data and NIHSS score both.,including 19 males and 15 females.The 34 patients were divided into hemorrhage group(HT group)and non-hemorrhage group(control group)according to the presence or absence of hemorrhage.There were 16 cases of HT(N = 16)and 18 cases of HT(N = 18).SPSS17.0 statistical software was used for statistical analysis.Spearman correlation analysis was used between PS value and NIHSS score in each group.Mann-Whitney U test was used between NIHSS score in two groups,with P < 0.05 as the significant difference.Results:1.Statistical results showed that the PS value(Z=-5.410,P<0.001)of the affected side were significantly higher than those of the opposite side in HT group,The PS value of the affected side was significantly higher than that of the contralateral side,and the CBV value(Z=-3.517,P<0.001)of the PS abnormal area was also significantly higher.while the CBF value was significantly lower(Z=-2.245,P=0.024).Compared with the control group,the PS value(Z=-5.065,P<0.001)and CBV value(Z=-3.458,P=0.001)of the affected side of HT group were significantly higher than those of the control group.There was no significant difference in CBF value between the two groups(Z=-1.729,P=0.084).ROC curve analysis showed that the AUC of diagnosing spontaneous HT in patients with acute ischemic stroke was 0.952 with PS value of 0.0324 ml/(100ml min)as the critical value.The specificity,sensitivity and accuracy were 82.60%,90.00% and 86.05% respectively.2.Among 34 patients with both CTP examination data and NIHSS score,there were 16 cases in the bleeding group,among the 16 cases,2 cases in grade 1,12.5%,2 cases in grade 2,12.5%,4 cases in grade 3,25%,3 cases in grade 4,18.8%,5 cases in grade 5,31.3%.Among the 18 cases in the control group,there were 1 cases in grade 1,5.6%,2 cases in grade 2,11.1%,7 cases in grade 3,38.9%,6 cases in grade 4,33.3%,2 cases in grade 5,11.1%.In hemorrhage group,there was no correlation between PS and NHISS score;in control group,there was no correlation between PS and NIHSS score.There was no significant difference in NIHSS score between HT group and control group.Conclusion:1.In this study,the changes of CTP perfusion parameters(PS)in the abnormal perfusion area are significantly different from those in the opposite side,which indicating that dynamic perfusion parameters could accurately reflect the hemodynamic changes in the local cerebral tissue.When PS value is greater than 0.0324 ml/(100ml min),the probability of spontaneous hematopoietic transformation increased.2.The PS value in this study can be used to predict the spontaneous HT in patients with acute ischemic cerebral infarction,which is helpful to make reasonable treatment plan in clinic.3.The statistical analysis of patients with both CTP examination data and NIHSS score showed that there is no correlation between PS value of microvascular permeability and NIHSS score.The PS value can not be used as a quantitative index to evaluate the degree of clinical neurological deficit in patients with ischemic cerebral infarction. |
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