Application Value Of CTP Combined With Multitemporal CTA In Predicting Prognosis Of Patients With Acute Ischemic Stroke

Objective: To explore the value of CT cerebral perfusion imaging(CTP)combined with multiphase CT cerebral angiography(CTA)in predicting the prognosis of patients with acute ischemic stroke.Methods: Thirty-six patients with acute ischemic stroke treated within 7 days of onset were collected.CTP combined with multi-phase CTA were performed within 10 days of onset.The collateral circulation was scored by ASPECTS collateral scoring method: the group with good collateral circulation opening(4-5 points)and the group with poor collateral circulation opening(0-3 points).Quantitative determination of CTP pseudo-color maps was performed to obtain perfusion parameters of different brain regions and infarct core area and volume.NIHSS score and modified Rankin score were used to evaluate the degree of neurological deficit and recovery at admission,discharge and 3 months after onset.The correlation between different imaging parameters and prognosis was analyzed.Result:1.The area under ROC curve(AUC = 0.700,P < 0.05)of NIHSS score improvement rate at discharge was significantly larger than that of NIHSS score at admission and NIHSS score at discharge.2.The difference of mRS score between good collateral circulation group and poor collateral circulation group at 3 months of onset and admission was significantly greater than that of poor collateral circulation group(P=0.001).There was a moderate negative correlation between collateral circulation score and mRS score at 3 months of onset(r=-0.410,P=0.014).The improvement rate of NIHSS score in patients with good collateral circulation at discharge(P=0.001)was significantly higher than that in patients with poor collateral circulation.The collateral circulation score was positively correlated with the improvement rate of NIHSS score at discharge(r = 0.672,P < 0.001).3.The rCBF of ischemic penumbra in good collateral circulation group was significantly higher than that in poor collateral circulation group(P=0.026).The rMTT of infarct core in good collateral circulation group was significantly longer than that in poor collateral circulation group(P=0.009).The rCBF in ischemic penumbra was negatively correlated with the 3-month mRS score(r=-0.390,P=0.030),and moderately positively correlated with the improvement rate of NIHSS score at discharge(r=0.426,P=0.017).4.The level of collateral circulation is the most powerful predictor of short-term prognosis(OR=0.67,P=0.012)and long-term prognosis(OR=0.239,P=0.007)in patients with acute ischemic stroke.Conclusion:1.CTP combined with multitemporal CTA can evaluate the level of collateral circulation and cerebral blood flow perfusion and predict the prognosis of patients with ischemic cerebrovascular disease.2.The improvement rate of NIHSS score at discharge was the best index to evaluate the recent improvement of neurological function.3.The level of collateral circulation is closely related to the prognosis of patients with ischemic stroke.The better the level of collateral circulation is,the better the prognosis is.4.Increased rCBF in ischemic penumbra is a characteristic marker of good collateral circulation opening and good prognosis.5.The level of collateral circulation and age were the main factors to evaluate the short-term and long-term prognosis of patients.The level of collateral circulation is the best predictor of prognosis in patients with ischemic stroke.