Quantitative Analysis And Prognostic Evaluation Of Whole Brain CT Perfusion Imaging On Collateral Circulation Of Ischemic Stroke

[Object]To explore the feasibility of quantitative assessment of collateral circulation of ischemic stroke by whole brain CT perfusion imaging,and to evaluate its value in the prognosis of ischemic stroke.[Methods]A total of 74 cases of ischemic stroke caused by unilateral middle cerebral artery stenosis or occlusion were diagnosed by clinical and multi-mode CT from June 2019 to December 2019 in the First Affiliated Hospital of Kunming Medical University.All patients were examined by multi-mode CT before treatment(CTP+whole brain CTP 16 cm or CTP+whole brain CTP 16 cm+head and neck CTA),and were followed up 90±7 days after onset.Use post-processing software to reconstruct and analyze multi-temporal CTA images Measure the time-density curve of each region of interest.Analyze multi-temporal CTA images to obtain intracranial blood vessel conditions and evaluate the compensation status of collateral circulation,and the patients were divided into three groups according to the method of WASID:The middle cerebral artery stenosis group,the severe middle cerebral artery stenosis group and the occlusion group;at the same time,based on the multi-phase CTA collateral circulation score,the patients in each group were divided into good collateral circulation group,medium collateral circulation group and Poor collateral circulation group.Choose three locations of the blood vessels at the distal part of the diseased part of the middle cerebral artery as the region of interest:the closest to the lesion(site 1),and the intermediate position between the lesion and the distal region(site 2),the most sudden cortical blood vessel(site 3)and measure its time-density curve to obtain the peak concentration(PV)and peak time(TP)values of each region of interest.The same method measures the time at the same position of the contralateral normal middle cerebral artery time-Density curve to obtain the peak concentration(PV)and peak time(TP)values as the normal control side.Compare the areas of interest in each collateral circulation grading group of patients with different degrees of stenosis in the unilateral middle cerebral artery and the normal control side the difference between PV and TP values between the two groups was explored to evaluate the feasibility of quantitative assessment of collateral circulation of ischemic stroke by PV and TP values of whole-brain CTP time-density curve.Patients were divided into good prognosis group and poor prognosis group according to mRS score after 90 days.Use binary logistic regression to analyze the relationship between baseline clinical data,neurological function scores and imaging parameters(PV and TP values in each region of interest)and clinical prognosis,draw the receiver operating characteristic curve(ROC),and calculate the curve under The area(AUC)analyzes the predictive value of imaging parameters(PV and TP values in each region of interest)to the patient's prognosis.[Results]1.General situation:Among 74 cases,unilateral middle cerebral artery stenosis was moderate in 18 cases(24.3%),including 7 cases with good collateral circulation(38.9%),5 cases with moderate collateral circulation(27.8%),and collateral circulation 6 cases were poor(33.3%),13 cases had a good prognosis(72.2%),5 cases had a poor prognosis(27.8%);26 cases(35.1%)had severe unilateral middle cerebral artery stenosis,and 13 cases(50%)had good collateral circulation),7 cases with moderate collateral circulation(26.9%),6 cases with poor collateral circulation(23.1%),17 cases with good prognosis(65.4%),9 cases with poor prognosis(34.6%);30 cases with unilateral middle cerebral artery occlusion(40.5%),including 12 cases with good collateral circulation(40.0%),9 cases with moderate collateral circulation(30.0%),9 cases with poor collateral circulation(30.0%),20 cases with good prognosis(66.7%),and poor prognosis 10 cases(33.3%).2.There are statistically significant differences between the diseased side and the normal control side of the three parameters of the collateral circulation grade group of patients with different degrees of stenosis in the unilateral middle cerebral artery,the three parameters of the PVsiteivalue,PVsite2 value,and PVsite3 value.Significance(p<0.05),in the unilateral middle cerebral artery middle and severe stenotic collateral circulation with good and medium groups,PVsite1value>PVsite3 value>PVsite2 value,in the remaining groups PVsiteivalue>PVsite2 value>PVsite3 value.In addition,there is no difference between the diseased side and the normal control side of the three parameters of TPsite1value,TPSite2value,TPsite3value Academic significance(p>0.05).3.In the unilateral middle cerebral artery with different degrees of stenosis,univariate and multivariate analysis results showed that PVsitei value,PVsite2 value,and PVsite3 value were related to the prognosis of ischemic stroke.ROC curve analysis showed that the curve of PVsite1 value the lower area(AUC)is the largest,and its predictive value for the clinical prognosis of ischemic stroke is higher than that of PVsite2 and PVsite3.[Conclusions]1.Whole-brain CT perfusion imaging was performed in patients with unilateral middle cerebral artery stenosis or occlusive ischemic stroke,and the peak density(PV)values of the near,middle and distal time-density curves of the responsible vessels were measured,which is a feasible quantitative evaluation method for collateral circulation.2.In patients with unilateral middle cerebral artery stenosis or occlusie ischemic stroke,the peak density(PV)values of the proximal,middle and distal responsible vessels were correlated with the clinical treatment effect,and the peak density(PV)values of the proximal responsible vessels were valuable in predicting the prognosis.