Predictive value of CT perfusion imaging parameters and thromboelogram for early neurological deterioration of acute anterior circulatory cerebral infarction

doi:10.3877/cma.j.issn.2095-9141.2024.04.006

Abstract

Abstract:

Objective

To explore the predictive value of CT perfusion imaging (CTP) parameters and thromboelogram (TEG) for early neurological deterioration (END) in acute anterior circulation cerebral infarction.

Methods

A total of 149 patients with acute anterior circulation cerebral infarction admitted to Neurology Department of Wuxi Huishan District People's Hospital from February 2021 to February 2023 were selected as the research subjects. Patients were divided into END group and non END group based on whether END occurred within 3 d of admission. The National Institutes of Health stroke scale (NIHSS) scores, time to peak ischemic zone (TTP), cerebral blood volume (CBV), cerebral blood flow(CBF),dynamic time(KT),and reaction time(RT)were compared between the two groups;CTP parameters and thromboelogram parameters for different causes of stroke were compared. Pearson method was used to analyze the correlation between NIHSS score and CBV, TTP, CBF, RT, KT; The multi factor binary Logistic regression model was used to analyze the independent influencing factors of END in patients with acute anterior circulation cerebral infarction; ROC curve was established to analyze the predictive performance of CTP and TEG related indicators.

Results

Among the 149 patients, there were 26 patients in the END group and 123 patients in the non END group. The difference in NIHSS scores between the two groups was statistically significant (P＜0.05). The TTP, CBV, and CBF in the ischemic area of patients in the END group were higher than those in the non END group, while KT and RT were lower than those in the non END group, and the differences were statistically significant (P＜0.05). According to Pearson analysis, NIHSS score was positively correlated with TTP, CBV, and CBF,and negatively correlated with RT (P＜0.05). The binary Logistic regression model analysis showed that TTP,CBV,CBF,KT,and RT were independent influencing factors of END in patients with acute anterior circulation cerebral infarction.ROC curve analysis showed that the AUC of TTP,CBV,CBF,KT,RT,and their combined prediction of END in patients with acute anterior circulation cerebral infarction were 0.759, 0.694, 0.758, 0.736, 0.794, and 0.965, respectively. The AUC of the combination of 5 indicators was compared with the AUC of TTP, CBV, CBF, KT, and RT, and the differences were statistically significant (P＜0.05).

Conclusion

CTP and TEG can effectively predict the END of patients with acute anterior circulation cerebral infarction,and have certain prognostic value.

Key words: Anterior circulation cerebral infarction, Early deterioration of neurological function, CT perfusion imaging, Thromboelastogram, Forecast

Gang Li, Xiaofan Pan, Xue Tian, LuLu Liu. Predictive value of CT perfusion imaging parameters and thromboelogram for early neurological deterioration of acute anterior circulatory cerebral infarction[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2024, 10(04): 226-232.

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Figures/Tables 7

Tab.1 Comparison of general information between two groups

项目	END组（n=26）	无END组（n=123）	χ ²/t值	P值
性别[例（%）]			0.022	0.882
男性	15（57.69）	69（56.10）
女性	11（42.31）	54（43.90）
年龄（岁， $\bar{x}$ ±s）	65.87±3.23	65.22±3.98	0.751	0.454
BMI（kg/m²， $\bar{x}$ ±s）	24.55±2.12	24.76±2.33	0.376	0.708
TOAST分型[例（%）]			0.070	0.999
大动脉粥样硬化	15（57.69）	70（56.91）
心源性栓塞	5（19.23）	25（20.33）
小动脉闭塞性卒中	2（7.69）	10（8.13）
其他明确病因卒中	2（7.69）	10（8.13）
病因不明卒中	2（7.69）	8（6.50）
NIHSS评分（分， $\bar{x}$ ±s）	5.23±1.22	2.39±0.57	18.197	＜0.001
入院收缩压（mmHg， $\bar{x}$ ±s）	135.78±6.22	135.95±6.34	0.105	0.916
入院舒张压（mmHg， $\bar{x}$ ±s）	87.54±3.22	87.89±3.15	0.522	0.602
血小板计数（×10⁹/L， $\bar{x}$ ±s）	235.27±12.33	234.98±13.22	0.103	0.918
白细胞计数（×10⁹/L， $\bar{x}$ ±s）	7.23±1.90	7.48±1.87	0.626	0.533
同型半胱氨酸（μmol/L， $\bar{x}$ ±s）	12.34±2.77	12.65±2.82	0.508	0.612
低密度脂蛋白（mmol/L， $\bar{x}$ ±s）	3.22±1.65	3.48±1.12	0.987	0.325
空腹血糖（mmol/L， $\bar{x}$ ±s）	6.98±1.22	6.56±1.34	1.479	0.141
超敏CRP（mg/L， $\bar{x}$ ±s）	2.33±0.98	2.57±0.77	1.375	0.171

Tab.1 Comparison of general information between two groups

项目	END组（n=26）	无END组（n=123）	χ ²/t值	P值
性别[例（%）]			0.022	0.882
男性	15（57.69）	69（56.10）
女性	11（42.31）	54（43.90）
年龄（岁， $\bar{x}$ ±s）	65.87±3.23	65.22±3.98	0.751	0.454
BMI（kg/m²， $\bar{x}$ ±s）	24.55±2.12	24.76±2.33	0.376	0.708
TOAST分型[例（%）]			0.070	0.999
大动脉粥样硬化	15（57.69）	70（56.91）
心源性栓塞	5（19.23）	25（20.33）
小动脉闭塞性卒中	2（7.69）	10（8.13）
其他明确病因卒中	2（7.69）	10（8.13）
病因不明卒中	2（7.69）	8（6.50）
NIHSS评分（分， $\bar{x}$ ±s）	5.23±1.22	2.39±0.57	18.197	＜0.001
入院收缩压（mmHg， $\bar{x}$ ±s）	135.78±6.22	135.95±6.34	0.105	0.916
入院舒张压（mmHg， $\bar{x}$ ±s）	87.54±3.22	87.89±3.15	0.522	0.602
血小板计数（×10⁹/L， $\bar{x}$ ±s）	235.27±12.33	234.98±13.22	0.103	0.918
白细胞计数（×10⁹/L， $\bar{x}$ ±s）	7.23±1.90	7.48±1.87	0.626	0.533
同型半胱氨酸（μmol/L， $\bar{x}$ ±s）	12.34±2.77	12.65±2.82	0.508	0.612
低密度脂蛋白（mmol/L， $\bar{x}$ ±s）	3.22±1.65	3.48±1.12	0.987	0.325
空腹血糖（mmol/L， $\bar{x}$ ±s）	6.98±1.22	6.56±1.34	1.479	0.141
超敏CRP（mg/L， $\bar{x}$ ±s）	2.33±0.98	2.57±0.77	1.375	0.171

Tab.2 Comparison of ischemic zone CTP parameters and TEG indicators between two groups (Mean±SD)

组别	例数	TTP（s）	CBV（mL/100 g）	CBF[mL/100（g·min）]	KT（min）	RT（min）
END组	26	32.85±4.23	11.31±2.41	23.81±3.33	1.31±0.47	4.27±0.53
无END组	123	27.90±5.40	9.38±2.46	19.94±3.95	1.78±0.41	4.89±0.45
t值		4.391	3.637	4.646	5.148	6.172
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

Tab.3 Comparison of ischemic zone CTP parameters and TEG indicators for different stroke etiologies (Mean±SD)

病因	例数	TTP（s）	CBV（mL/100 g）	CBF[mL/100（g·min）]	KT（min）	RT（min）
大动脉粥样硬化	15	31.25±3.99	11.65±2.33	22.45±3.33	1.22±0.33	4.19±0.65
心源性栓塞	5	30.52±3.74	11.19±2.52	21.79±3.22	1.19±0.41	4.01±0.22
小动脉闭塞性卒中	2	32.78±3.75	11.78±2.19	22.71±3.19	1.36±0.56	4.39±0.48
其他明确病因卒中	2	33.45±4.49	12.75±2.51	24.78±2.36	1.05±0.32	3.78±0.65
病因不明卒中	2	29.86±5.89	10.39±2.45	23.15±2.84	1.49±0.85	4.58±0.44
F值		0.210	0.148	0.291	0.181	0.355
P值		0.930	0.962	0.880	0.945	0.837

Tab.4 Correlation between NIHSS score and ischemic zone CTP parameters and TEG indicators

指标	r值	P值
TTP	0.481	＜0.001
CBV	0.386	＜0.001
CBF	0.501	＜0.001
KT	0.129	0.117
RT	-0.343	＜0.001

Tab.5 Multivariate binary Logistic regression analysis of the impact of early neurological deterioration in patients with acute anterior circulation cerebral infarction

指标	偏回归系数	标准误	Wald值	P值	OR值	95%CI
TTP	-0.193	0.050	14.677	＜0.001	0.825	0.747～0.910
CBV	-0.334	0.102	10.759	0.001	0.716	0.587～0.874
CBF	-0.267	0.067	15.786	＜0.001	0.765	0.671～0.873
KT	2.079	0.478	18.964	＜0.001	8.000	3.138～20.396
RT	1.868	0.411	20.637	＜0.001	6.475	2.892～14.495

Fig.1 ROC curve for predicting early neurological deterioration in patients with acute anterior circulation cerebral infarction using TTP,CBV,CBF,KT,RT,and five combinations

Tab.6 Predictive efficacy of CTP and TEG related indicators in predicting early neurological deterioration in patients with acute anterior circulation cerebral infarction

变量	曲线下面积	标准误	P值	渐近95%CI	临界值	约登指数	敏感性（%）	特异性（%）
TTP	0.759	0.045	＜0.001	0.670～0.848	28.5 s	0.413	88.5	52.8
CBV	0.694	0.055	0.002	0.587～0.802	8.5 mL/100 g	0.348	88.5	46.3
CBF	0.758	0.043	＜0.001	0.674～0.842	20.5 mL/100（g·min）	0.482	96.2	52.0
KT	0.736	0.057	＜0.001	0.625～0.848	1.5 min	0.472	69.2	78.0
RT	0.794	0.055	＜0.001	0.686～0.903	4.5 min	0.611	69.2	91.9
5项联合	0.965	0.014	＜0.001	0.938～0.992	-6.625	0.829	100.0	82.9

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