基于CT灌注成像和PRx建立aSAH后迟发性脑缺血发生风险Nomogram图预测模型及临床效用OA

Objective:To establish a Nomogram prediction model for the risk of delayed cerebral ischemia(DCI)after aneurysmal subarachnoid hemorrhage(aSAH)based on CT perfusion imaging and initial pressure reactivity index(PRx),and evaluate its clinical application value.Methods:This study retrospectively analyzed the data of 150 patients with aSAH admitted to our hospital from January 2022 to January 2023.These patients were divided into a model-building cohort(105 cases)and an external validation cohort(45 cases).We used the random forest algorithm to screen for key factors affecting DCI,and based on this,we constructed a Nomogram to predict DCI risk.Results:After 72 hours,factors such as cerebral blood flow(CBF),PRx,time to peak(TTP)after 72 hours,cerebral blood volume(CBV),mean transit time(MTT)after 72 hours,Glasgow Coma Scale(GCS)score,and time to peak(TTP)within 24 hours have the greatest impact on the risk of DCI.The constructed Nomogram has a C-index of 0.925,and decision curve analysis(DCA)shows that it has significant clinical net benefit.Conclusion:This study successfully established a DCI risk prediction model based on CT perfusion imaging and PRx,demonstrating good predictive performance and providing a practical tool for clinicians to identify high-risk patients with DCI at an early stage.