Formulation And Application Research Of CT Scores Strategy About Acute Cerebral Ischemia

Objective: Establishing a rapid complete visual grading systems is evaluated the early cerebral ischemia in patients with the first option of CT and discussed the relevance of the National Institutes of Health Stroke Scale(NIHSS score). We can identify the high-risk patients by studying the predictive diagnosis of cerebral ischemia, meanwhile making the correct treatment plan in the first time, reducing the morbidity and mortality of patients, and improving the prognosis of the quality of life.Methods:1 This is a prospective study which we collected all of the routine brain CT examinations data from the patients which were at the treatment in the Second Hospital of Hebei Medical University during December 2013-June 2014 appearing the symptoms of cerebral ischemia for the first time. We do routine MRI and DWI examinations for our standard patients(patients with first onset and onset time < 24 hours, with the exception of cerebral hemorrhage and without the related of the damage to the responsibility of the lesions) within 48 hours.2 Medical history taking, do NIHSS scores after the brain CT examination patients within 24 hours and fill in data of cases(micro stroke less than 5 marks, ordinary stroke between 5 and 14 marks, serious stroke more than 14 marks). Less than 5 marks indicate good prognosis and more than 14 marks indicate that patients could die or have severe disability.3 Make double-blind diagnosis according to cerebral ischemia CT diagnosis strategy process for standard patients. Divide the results into positive and negative groups according to the MRI and DWI check results whether found the acute infarcts and record the first diagnosis of brain CT details whether patients appear the following early manifestation: the early low density, the change of brain sulci fissures cistern, the change of the ventricle, gray white matter structure disorder, lentiform nucleus edge blur and vascular hyperdense. If it appears that record ‘1’, not record ‘0’.4 Analyze the relationship between the first diagnosis of brain CT early manifestation and whether appear the acute infarcts in final MRI and DWI check. Use the early CT manifestation as covariate and whether appear the acute infarcts as dependent variables to do multivariable Logistic regression analysis, select meaningful early manifestation and do the subjective rating.5 Statistically analyzed the correlation between the final score of the first brain CT diagnosis and the NIHSS scores by Spearman’s rank correlation test.6 According to the final score of patients by the first CT divide into three groups: micro stroke less than 5 marks, ordinary stroke between 5 and 12 marks, serious stroke more than 12 marks. After 3 months, telephone follow-up patients to know the progress of the disease. Divide patients into three groups according to the actual condition: group A was complete recovery; group B was incomplete recovery, but could live independently; group C was death(cerebral infarction was the direct cause of death) or severe disability7 Calculate CT scores and NIHSS scores predicting the ischemic patients progression of disease result accuracy after three months, and compare them whether had statistics difference through marching chi-square test.Results:1 NIHSS score less than five marks: DWI positive were 11 patients, DWI negative were 91 patients, group A were 82 patients, group B were 7 patients, group C were 0 patients; NIHSS score between 5-14 marks: DWI positive were 6 patients, DWI negative were 58 patients, group A were 10 patients, group B were 41 patients, group C were 3 patients; NIHSS score more than 14 marks: DWI positive were 9 patients, DWI negative were 0 patients, group A were 0 patients, group B were 0 patients, group C were 6 patients. The NIHSS score more than 14 marks in patients were also more than 12 marks with computed tomography(CT) scores.2 Early low density’s sensitivity is 39% and specificity is 92.8%; the change of brain sulci fissures cistern’s sensitivity is 27.6% and specificity is 96.9%; the change of ventricle structure’s sensitivity was 26.7% and specificity is 80.4%; the disorder of gray white matter structure’s sensitivity is 45.8% and specificity is 97.9%; lentiform nucleus edge blur sensitivity is 57.1% and specificity is 99%; vascular hyperdense sensitivity is 39% and specificity is 74%.3 In addition to the change of ventricle structure, the relationship between the early cerebral ischemia CT manifestation and the final appearance of acute infarcts come into the danger model, showed statistically significant. The coefficient of relative risk, respectively: early low density shadow(1.72), the change of brain sulci fissures cistern(1.89), gray white matter structure disorder(1.70), lentiform nucleus edge blur(1.72) and the related zone of vascular hyperdense(0.69). Odds ratio are 5.591、6.594、5.465、5.574、1.988 respectively. Subjective scoring: the change of ventricle structure(1 mark), vascular hyperdense(2 marks), gray white matter structure disorder(3 marks), the early low density and lentiform nucleus edge blur(4 marks), the change of brain sulci fissures cistern(5 marks).4 The statistics analysis result suggested that the early cerebral ischemia CT scores was correlated with the NIHSS scores, Rs=0.72,P=0.000.5 Patients with early cerebral ischemia CT scores and the actual condition ending after three months accuracy is 78.5%, and NIHSS score prediction accuracy is 84.6%, through matching chi-square test P = 0.188, no statistical differences, explaining the consistency of both is good.Conclusion:1 The DWI positive rates in serious stroke patients were significantly higher than patients in micro stroke, and the corresponding CT scores were also higher.2 The earlier low density shadow, the change of brain sulci fissures cistern, gray white matter structure disorder, lentiform nucleus edge blur and vascular hyperdense of the first diagnosis brain CT of the early cerebral ischemia can predictive diagnosis of cerebral ischemia and guide the clinician that patients with early manifestation should be remained in hospital under observation.3 Evaluate the value of the various brain structure changes after cerebral ischemia respectively, the change of cerebral ventricle structure as the indirect signs mean little to the diagnosis; lentiform nucleus edge blur’s sensitivity and specificity are the highest.4 For the short-term prediction and the development illness condition of patients with acute cerebral ischemia, the CT scores and NIHSS scores have no statistical differences.5 The early cerebral ischemic rating scale has a certain significance, and it can significantly predict cerebral ischemic risk events and predictively diagnose patients. The CT scores less than 5 marks show patients have good prognosis after three months; the CT scores more than 12 marks show patients have serious prognosis after three months.