Value Analysis Of Cerebral CT Perfusion Imaging In Cognitive Function And Prognosis In Patients With Middle Cerebral Artery Stenosis

BackgroundThe middle cerebral artery is one of the vessels most frequently involved in intracranial atherosclerosis.Atherosclerosis in the brain can present with varying degrees of narrowing or occlusion of blood vessels.Which can result in stroke,cognitive decline,and mental abnormalities in the Clinic.It is not only a risk factor for ischemic stroke,but also may be closely related to the cognitive decline cognitive decline.At present,with the development of imaging technology,the CTP of brain compensates for the inability of conventional CT to obtain hemodynamic parameters.It can intuitively reflect the perfusion of blood flow in brain tissue,and it can guide the early treatment of ischemic stroke.Which has important application value in reflecting the cognitive function of patients,screening patients with middle cerebral artery stenosis for intravascular treatment,and judging the prognosis of the disease.ObjectiveTo investigate the relationship between brain CT perfusion parameters,cognitive function and prognosis in patients with middle cerebral artery stenosis based on cerebral CTP.MethodsA total of 89 patients with unilateral middle cerebral artery stenosis treated in the First Affiliated Hospital of Xinxiang Medical College from October 2018 to June 2020 were selected as the study subjects.Baseline clinical information was recorded for all subjects,they all underwent the brain CT perfusion examination,the Montreal Cognitive Assessment（Mo CA）and Mini metal state examination（MMSE）,then they were followed up for 12 months for recurrence of stroke.In the end,56 participants were included.Patients with middle cerebral artery（MCA）stenosis were divided into normal cerebral perfusion group（n=21）,compensated cerebral perfusion group（n=17）and decompensated cerebral perfusion group（n=18）according to the results of CTP cerebral perfusion imaging.The relative values of cerebral perfusion parameters of the affected side and the healthy side in the area of interest were recorded detailedly.The differences of cerebral perfusion parameters and cognitive function among the three groups were analyzed.According to the follow-up,the patients were divided into the recurrent stroke group and the non-recurrent stroke group.To compare the differences of Baseline data and perfusion parameters between the two groups.Multivariate Logistic regression analysis was performed for indicators with statistically significant differences.Receiver operating characteristic curve（ROC）was used to evaluate the predictive value of cerebral perfusion parameters for the recurrent stroke in patients with MCA stenosis.Results（1）There were no significant differences in age,sex,number of hypertension,number of diabetes,TC,TG and other baseline data between the normal group,compensatory group and the decompensated group（P>0.05）.The values of r CBV and r CBF in the normal group,the compensatory group and the decompensated group gradually decreased,while the values of r MTT and r TTP gradually increased and there were differences among the three groups（P<0.001）.Pairwise comparisons between the three groups showed that between the normal group and the compensated group,r CBV（P=0.002）,r CBF（P<0.001）,r TTP（P<0.001）.The normal group and the decompensated group,r CBV（P<0.001）、r CBF（P<0.001）、r MTT（P<0.001）、r TTP（P<0.001）.The decompensated group and the compensatory group,r CBV（P<0.001）、r MTT（P<0.001）、r TTP（P<0.001）.They have group-to-group differences.（2）MMSE score and Mo CA score of cerebral perfusion decompensation group were respectively（19.72±2.29）and（19.61±1.61）.They were all lower than MMSE score and Mo CA score in normal cerebral perfusion [MMSE score（26.80±2.11）;Mo CA score（25.19±1.77）] group and compensatory group[MMSE score（22.41±2.42）;Mo CA score（21.41±1.62）],（both P<0.05）.The visual space and executive function,delayed recall were（3.11±0.69,2.70±0.77）in the cerebral perfusion compensation group.But in the decompensated group were（1.94±0.72,2.00±0.76）.They all significantly lower than normal group（4.28±0.78,3.85±0.85）,（both P<0.05）.The directivity of normal cerebral perfusion was（4.42±8.87）,which is higher than that of decompensatory group（3.61±0.97）and compensatory group（3.41±0.87）,（P<0.05）,but there was no significant difference between decompensatory group and compensatory group.The incidence of end point events within 12 months in the decompensated group was higher than that in compensatory group and normal group,（P<0.05）.（3）The r CBV,r CBF were positively correlated with Mo CA score（r = 0.698,P<0.001;r = 0.656,P<0.001）.The r MTT,r TTP were negatively correlated with Mo CA score（r =-0.471,P<0.001;r =-0.588,P<0.001）.（4）There were no significant differences in gender,age,hypertension,diabetes cases,TG,TC,HDL-C,LDL-C between the recurrent stroke group and the non-recurrent stroke group（P>0.05）.The r MTT and r TTP values of cerebral perfusion in the recurrent stroke group were significantly higher than those in the control group（the group was no recurrent stroke）,while the levels of r CBV and r CBF were significantly lower than those in the control group,the differences were statistically significant,（P<0.05）.After correcting for confounding factors,multivariate analysis was performed on the indicators with statistically significant differences and it was found that the r CBV value OR 0.004（0.026-1.381）,it was the influencing factor for the recurrence of stroke.The r CBV has certain predictive value for recurrent stroke in patients with middle cerebral artery stenosis,the area under the ROC curve is 0.841（95%CI;0.739～0.943,P<0.001）.Conclusions1.Cognitive decline in patients with middle cerebral artery stenosis is associated with hypoperfusion and decompensated patients are more prone to stroke events in the short term.2.Cerebral perfusion parameters are related to the prognosis of patients with MCA stenosis,and r CBV has certain predictive value for recurrent stroke in patients with middle cerebral artery stenosis.