多模态CT在急性缺血性脑卒中的应用研究

发布时间：2018-04-17 02:05

本文选题：急性缺血性脑卒中 + 多模态CT　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:研究多模态CT在急性缺血性脑卒中患者的应用,探讨患者多模态CT的不同评分与最终梗死核心的相关性,并评估其在预测非保守治疗患者预后的应用价值。方法:收集2015年12月至2016年12月经吉林大学第一医院绿色通道就诊于神经内科的急性缺血性脑卒中患者,分别接受“多模态CT检查”,包括CT平扫、CT灌注和CTA,所有患者在发病一周内接受CT或MRI-DWI序列复查。对所有患者进行CT平扫、CT灌注及复查ASPECTS。根据患者治疗方案分成保守治疗与非保守治疗,非保守治疗的患者根据3个月后的预后情况分为两组:预后好组(m RS≤2)和预后差组(m RS2)。CT平扫及CTP ASPECTS与复查ASPECTS的相关性采用Spearman相关性分析;患者CT平扫及CTP ASPECTS在预后的差异性使用Wilcoxon符号秩和检验;CT平扫及CTP ASPECTS对预后的预测诊断意义采用ROC曲线分析。用Pearson相关分析评价不同评定者之间的一致性。P0.05为有统计学意义。结果:67例患者纳入研究,保守治疗者37例,非保守治疗者30例,男性49例,女性18例,平均年龄61.7岁(42~83岁)。平均CT平扫、CTP、复查ASPECTS分别为8.7分(2~10分)、8.2分(1~10分)、6.8分(1~10分)。保守治疗的患者,CT平扫ASPECTS、CTP ASPECTS与复查ASPECTS均呈正相关,相关系数r分别为0.490、0.621,均有统计学意义;非保守治疗的患者,CT平扫ASPECTS、CTP ASPECTS与复查ASPECTS均呈正相关,相关系数r分别为0.758、0.856,均有统计学意义。在预后好组与预后差组,CT平扫ASPECTS、CTP ASPECTS的差异均有统计学意义,P0.05。比较不同评分对预后的预测效果,CT平扫ASPECTS评分的ROC曲线下面积为0.741,CTP ASPECTS曲线下面积为0.787。结论:(1)急性缺血性脑卒中患者多模态CT的ASPECTS有助于评估患者的最终梗死核心。(2)急性缺血性脑卒中患者多模态CT的ASPECTS有助于预测非保守治疗患者的预后情况。(3)多模态CT的应用有助于急性缺血性脑卒中患者的早期诊断、病情评估及判断预后,可以更好地指导临床治疗方案的选择。
[Abstract]:Objective: to study the application of multimodal CT in patients with acute ischemic stroke, to explore the correlation between the different scores of multimodal CT and the final infarct core, and to evaluate the value of multimodal CT in predicting the prognosis of patients with non-conservative treatment.Methods: the patients with acute ischemic stroke in the first Hospital of Jilin University from December 2015 to December 2016 were collected from the Department of Neurology and received "multimodal CT examination".All patients received CT or MRI-DWI reexamination within one week of onset, including CT perfusion and CT perfusion.All patients were performed CT plain scan CT perfusion and ASPECTS.According to the patient's treatment plan, it can be divided into conservative treatment and non-conservative treatment.Patients with non-conservative treatment were divided into two groups according to the prognosis after 3 months: the patients with good prognosis were divided into two groups: the patients with good prognosis and those with poor prognosis were divided into two groups: Spearman correlation analysis was used to analyze the correlation between RS2).CT plain scan and CTP ASPECTS in poor prognosis group and re-examination ASPECTS.The difference of prognosis between CT plain scan and CTP ASPECTS using Wilcoxon sign rank sum test the significance of CT plain scan and CTP ASPECTS in predicting prognosis was analyzed by ROC curve.Pearson correlation analysis was used to evaluate the consistency among different evaluators. P0.05 was statistically significant.Results 67 patients were included in the study. There were 37 cases of conservative treatment, 30 cases of non-conservative treatment, 49 cases of male and 18 cases of female. The average age was 61.7 years old or 42 to 83 years old.The average CT plain CT scan showed that the ASPECTS was 8.7m ~ (10) ~ (?) ~ (8.2) ~ (10) and 6.8m ~ (-1) ~ (10) respectively.There was a positive correlation between CT plain scan and ASPECTS, r = 0.490 卤0.621 (r = 0.490 卤0.621), and there was a positive correlation between CT plain scan and re-examination of ASPECTS in patients with non-conservative treatment, and there was a positive correlation between CT plain scan and re-examination of ASPECTS in patients with conservative treatment, the correlation coefficient was 0.490 卤0.621, respectively, and there was a positive correlation between CT plain scan and re-examination of ASPECTS in non-conservative patients.The correlation coefficient (r) was 0.758 and 0.856, respectively, with statistical significance.There were significant differences in CT plain scan ASPECTS between good and poor prognosis groups (P 0.05).The area under the ROC curve of CT plain scan ASPECTS score was 0.741% and the area under ASPECTS curve was 0.787.Conclusion the ASPECTS of multimodal CT is helpful to evaluate the final infarct core of acute ischemic stroke patients. The ASPECTS of multimodal CT can predict the prognosis of patients with acute ischemic stroke.The application of CT is helpful to the early diagnosis of acute ischemic stroke.The evaluation and judgment of prognosis can better guide the choice of clinical treatment.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R816.1;R743.3

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