定义大核心心脏病发作:比较非对比CT ASPECTS与CT perfusion核心体积的准确性
Ngoc Mai Le1, Joseph Samaha1, Ananya S Iyyangar1
1Department of Neurology, McGovern Medical School at UTHealth, Houston, Texas, USA.
概括
无对比头部计算机断层扫描 (NCHCT) 和CT输液 (CTP) 显示,在接受内血管治疗 (EVT) 的急性缺血性中风 (AIS) 患者中识别大核心心脏病发作方面存在轻微一致. 两种成像技术都无法有效预测最终的心脏病发作量或临床结果.
科学领域:
- 神经学 神经学
- 放射学 放射学是一门学科.
- 医疗成像医学成像
背景情况:
- 由于大血管封闭 (LVO) 的急性缺血性中风 (AIS) 需要及时干预.
- 内血管治疗 (EVT) 是LVO-AIS的关键治疗方法.
- 准确评估心脏病核心大小对于治疗决策和预测结果至关重要.
研究的目的:
- 评估非对比头部计算机断层扫描 (NCHCT) 和CT perfusion (CTP) 在确定接受EVT的LVO-AIS患者的大型心脏梗塞方面的协议和性能.
- 将NCHCT和CTP与MRI定义的最终心脏病发作量 (FIV) 进行比较,作为参考标准.
- 评估NCHCT和CTP对90天功能独立性的预测能力.
主要方法:
- 一个潜在的多中心注册表确定了接受EVT的LVO-AIS患者.
- 最终心脏病发作体积 (FIV) 用扩散权重成像MRI在EVT后24-48小时确定.
- 大型心脏梗塞是由FIV值 (50,70,100毫升) 定义的;使用kappa统计数据评估一致性,使用AUC-ROC评估分类准确性.
主要成果:
- 在241名接受EVT治疗的患者中,NCHCT和CTP在识别大核心心脏病发作方面显示出轻微的一致性 (κ = 0.192).
- 与MRI-FIV相比,这两种模式对大核心心脏病发作都有弱至可接受的歧视 (AUC-ROC:0.61-0.72).
- 对于90天的功能独立,NCHCT和CTP的预测能力有限 (AUC-ROC:0.63-0.65).
结论:
- 在接受EVT的LVO-AIS患者中,NCHCT和CTP在对心脏梗塞核心大小的分类上有有限的共识.
- 两种成像技术都不能有效地预测最终的心脏病发作量或90天的功能结果.
- 可能需要进一步的研究来确定最佳的成像生物标志物,用于在AIS中指导EVT.
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