颅脑CT灌注成像对脑梗死患者预后的预测价值OA

Objective To explore the predictive value of cranial CT perfusion imaging(CTPI)for the prognosis of patients with cerebral infarction.Methods A total of 150 patients with acute cerebral infarction admitted to the Affiliated Hospital of Panzhihua University from January 2020 to May 2025 were selected.All patients underwent non-contrast cranial CT and CTPI within 24 hours of symptom onset.Post-processing software was used to quantitatively analyze perfusion parameters of the infarct core and ischemic penumbra,including cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT),and time to peak(TTP).Based on the modified Rankin Scale(mRS)score at 90 days post-onset,patients were divided into the favorable prognosis group(mRS≤2,n=97)and the unfavorable prognosis group(mRS>2,n=53).Receiver operating characteristic(ROC)curves were employed to evaluate the predictive efficacy of CTPI parameters for patient outcomes,while multivariate logistic stepwise regression analysis was conducted to identify independent prognostic factors for cerebral infarction.Results CBF and CBV in the unfavorable prognosis group were significantly lower than those in the favorable prognosis group,while MTT and TTP were significantly longer than those in the favorable prognosis group(P<0.05).ROC curve analysis showed that the AUC of CBF,CBV,MTT,TTP,and the combination of the four parameters(in series)for predicting the prognosis of patients with cerebral infarction were 0.793(95%CI:0.748-0.843),0.749(95%CI:0.699-0.794),0.702(95%CI:0.657-0.752),0.758(95%CI:0.713-0.808),and 0.924(95%CI:0.879-0.974),respectively.The De-Long test showed that the AUC of the combined prediction was significantly higher than that of each individual parameter(all P<0.05).The proportion of patients with older age,admission National Institutes of Health Stroke Scale(NIHSS)score>15,and severe infarction was significantly higher in the unfavorable prognosis group than in the favorable prognosis group(P<0.05).Multivariate analysis showed that increased age(OR=1.846,95%CI:1.068-3.189),CBV<2.80 mL/100 g(OR=1.919,95%CI:1.190-3.096),MTT>7.68 s(OR=2.010,95%CI:1.179-3.425),TTP>17.22 s(OR=2.018,95%CI:1.134-3.590),admission NIHSS score>15(OR=2.445,95%CI:1.475-4.054),and CBF<35.84 mL/(100 g·min)(OR=2.489,95%CI:1.546-4.008)were independent risk factors for the prognosis of patients with cerebral infarction(all P<0.05).Conclusion Cranial CTPI parameters have important predictive value for the prognosis of patients with cerebral infarction,and the predictive efficacy of multi-parameter combined analysis is significantly better than that of a single parameter.Additionally,age,admission NIHSS score,and multiple CTPI parameters are independent influencing factors for unfavorable prognosis in patients with cerebral infarction.