The Value Of Multimodal CT In The Assessment Of Ischemic Core, Penumbra And Collateral Circulation Of Acute Ischemia Stroke

Objective:To investigate the value of multimodal CT in the evaluation of infarct core,ischemic penumbra and collateral circulation in patients with acute ischemic stroke.Methods:In this retrospective study,we collected patients with acute ischemic stroke from neurology department in the first hospital of Jilin university from January 2018 to June 2018.The inclusion criterions:(1)patients age from 18 to 80 years(2)Patients with anterior circulation stroke who underwent multimodal CT in 24 hours after stroke onset.(3)with following CT or MRI imaging?All cases must meet the above three points at the same time.All examinations were approved by the patients and the ethics committee,and then the patients signed informed consent.According to the data collected,the data were divided into two parts.The first part has 80 cases with multimodality CT,1-2days of review CT scan or MRI scan data.Software was used to analysis CTP original image.We mainly studied the CTP parameters(include CBV?CBF?MTT?TTP)for the infarction core and penumbra prediction.CBVASPECTS were also calculated.The second part included 69 cases with multimodality CT,patient general condition and prognosis data.The multiphase CTA was used to analyze the intracranial vessels and evaluate the collateral circulation,according to the prognosis of MRS score in 90 days.SPSS 26.0 software was used for statistical analysis.Results:Part IThere were significant differences in the CTP parameters between the infarcted core area and contralateral mirror image(normal cerebral perfusion zone),all of which were statistically significant,P<0.05,while in the penumbra area,there were significant differences in the CBF?MTT?TTP parameters were statistically significant with contralateral mirror image,not CBV(P=0.214).In 24 hours after onset,CTP-CBV ASPECTS showed better agreement with consensus reads(ICC= 0.901;95% CI,0.704-0.981)than CT ASPECTS(ICC=0.82;95% CI,0.431-0.952).Divide into two groups according to window time,in early team(0-6h),there was no agreement between CT ASPECTS and review ASPECTS,while CTP-CBV ASPECTS showed excellent agreement with review ASPECTS(ICC=0.893;95% CI,0.538-0.985),P<0.05.In late team(6-24h),CT ASPECT scores were comparable with CTP-CBV ASPECTS in patients,(ICC= 0.754;95% CI,0.651-0.892)and(ICC=0.932;95% CI,0.751-0.983)respectively,P<0.05.NCCT and CBV ASPECTS are negatively correlated with review volume,ASPECTS of CBV parameter evaluation showed a still further negative correlation,with correlation coefficient r=-0.942,with statistical significance(P<0.05).Part IIThe relationship between collateral circulation and the general condition of patients showed that the degrees of MCA stenosis collateral circulation were different(x2=11.281,P<0.01),indicating that the higher the degree of vascular stenosis,the higher the probability of good compensation for collateral circulation.T test was used for comparison m RS scores between poor collateral circulation group and good collateral circulation group,t=-4.39,with statistical significance(P< 0.05).T test was used for comparison final infarct volumes between poor collateral circulation group and good collateral circulation group,t=-6.306,shows statistical significance(P< 0.05).Conclusions:(1)Multimodal CT(CTP)is helpful in prognosis of the infarct core and penumbra in patients with acute ischemic stroke.(2)CTP ASPECT score was more accurate than CT ASPECT score in 24 hours after onset.(3)CT and CTP ASPECT scores were negatively correlated with the volume of final infarct core.(4)Collateral circulation may be associated with the extent of middle cerebral artery stenosis,the higher the stenosis degree was,the better the collateral circulation would be.(5)Multiphase CTA can assess collateral circulation,which is helpful for assessment of patient outcomes with acute ischemic stroke.