Prognostic Value Of Quantitative Perfusion Computed Tomography In Patients With Acute Ischemic Stroke

【Background】Acute ischemic stroke is characterised by high morbidity and disability,and the most effective treatment is intravenous thrombolysis and endovascular therapy.However,some patients in clinical practice do not receive intravenous thrombolysis and endovascular therapy,even within the time-window,for various reasons.The prognosis of patients with acute ischemic stroke is particularly important as the neurological deficits that remain are a heavy burden on families and society.Most studies of cranial CT perfusion tomography（CTP）have focused on assessing the clinical prognosis of patients with acute ischemic stroke after intravenous thrombolysis and endovascular therapy,whereas the prognosis of patients with acute ischemic stroke who have not received intravenous thrombolysis and endovascular therapy within 24 hours of onset has rarely been quantitatively analysed by cranial CTP.A quantitative analysis of the prognosis of acute ischemic stroke patients not treated with intravenous thrombolysis and endovascular therapy within 24 hours of onset has rarely been reported^[1,2].【Objective】To investigate the use of Perfusion Computed Tomography（CTP）to assess the clinical prognosis of patients with acute Ischemic Stroke who have not received intravenous thrombolytic and endovascular therapy within 24 hours of onset.【Subjects and method】Patients with Acute Ischemic Stroke who attended the Second Hospital of Guangzhou Medical University and completed cranial CTP between April 2022 and November 2022 were retrospectively analyzed,and their baseline data and CTP parameters were collected.Patients were divided into good prognosis group（m RS score≤2）and poor prognosis group（m RS score>2）according to the m RS score after3 months.Baseline information such as Gender,Age,Smoking,Drinking,Hypertension,Diabetes,Coronary Heart Disease,Hyperlipidaemia,Blood Pressure,Creatinine,NIHSS score at admission and CTP parameters including V_Tmax>8s、VTmax>6s、VTmax>4s;V_rCBF<20%、V_rCBF<30%、V_rCBF<40%;Vr CBV<35%)、Vr CBV<40%)、V_{r CBV<45%}were compared between the two groups.Dichotomous logistic regression analysis was used to screen the predictors and obtain the prediction formulae.Finally,ROC curves were applied to evaluate their predictive ability.【Results】A total of 118 patients with Acute Ischemic Stroke were finally included,including 40 patients in the poor prognosis group and 78 patients in the good prognosis group.The age and NIHSS score at admission were higher in the poor prognosis group than in the good prognosis group,and the differences were all statistically significant（P<0.05）.V_Tmax>8s、V_Tmax>6s、V_Tmax>4s;V_rCBF<20%、V_rCBF<30%、V_rCBF<40%;Vr CBV<35%)、Vr CBV<40%)、Vr CBV<45%)were all higher in the poor prognosis group than in the good prognosis group,and the differences were all statistically significant（P<0.05）.Logistic regression analysis showed V_rCBF<30%and V_Tmax>4sas factors influencing poor prognosis in patients with Acute Ischemic Stroke（OR=1.044,95%）CI 1.006-1.083,P=0.024;OR=1.004,95%)CI 1.000-1.007,P=0.039).The prediction equation was Logit（P）=-1.456+0.043 x V _rCBF<30%+0.004x V _Tmax>4s.ROC curve analysis showed an AUC=0.654（95%）CI 0.542 to 0.767)for V_rCBF<30%with a cross-section of 5.5 ml;AUC=0.704 for V_Tmax>4s（95%）CI 0.600 to0.808)with a cross-section of 3.75 ml.【Conclusions】（1）Age、pre-admission NIHSS score、V_Tmax>10s、V_Tmax>8s、V_Tmax>6s、V_Tmax>4s、V_rCBF<20%、V_rCBF<30%、V_rCBF<40%、Vr CBV<35%)、Vr CBV<40%)、Vr CBV<45%)were strongly associated with Acute Ischemic Stroke prognosis.（2）V_rCBF<30%and V_Tmax>4swere independent predictors of prognosis in patients with Acute Ischemic Stroke,and the greater the V_rCBF<30%and V_Tmax>4s,the worse the prognosis of patients.（3）V_rCBF<30%=5.5 ml or V_Tmax>4s=3.75 ml is the threshold for assessing prognosis in acute ischemic stroke.