中国卒中杂志2012，Vol.7Issue(3)：178-184,7.
建立急性缺血性卒中的临床/多模式CT预后评分系统
Developing Clinical/Multimodai Computed Tomography Score and Predicting Clinical Outcome in Acute Ischemic Stroke
摘要
Abstract
Objective To develop a clinical/multimodal computed tomography score(CMCTS) system based on National Institute of Health Stroke Scale(NIHSS) and multimodal CT scores(MCTS), which was used to guide clinical treatment and clinical assessment of functional recovery after 90 days. Methods Multimodal CT examination including non-contrast enhanced CT(NCCT), CT Perfusion(CTP), CT angiography(CTA) were performed in 49 patients with symptoms of stroke less than 9 hours. The Alberta Stroke Program Early CT Score(ASPECTS) were analyzed on NCCT, arterial phase CT perfusion source images(ACTP-SI) and venous phase CTP-SI(VCTP-SI) then the follow up imaging ASPECTS. Thrombolysis in Cerebral Ischemia Scale(TICI) were analyzed on CTA, Baseline NIHSS and 90 days modified Rankin Scale(mRS) were assessed in each patient with the 90 days good clinical functional recovery(mRS<2) as a standard, Application of receiver operating characteristics(ROC) to determine the threshold of NIHSS and CT parameters;in accordance with the threshold score obtain multi-mode CT scoring system, the baseline NIHSSscore join multi-mode CT scoring system obtain clinical/multi-mode CT score. Finally, applicationof ROC curve analysis efficacy of each model predicting clinical outcome.Results The optimal threshold measured on CMCTS, MCTS, NCCT ASPECTS, arterial phaseCTP-SI, venous phase ASPECTS, CTA TICI and NIHSS were>l, >1, >9, >6.5, >8.5, >1 and 3*7,respectively. The parameter that most accurately describes good clinical outcome 3 months afterstroke is the CMCTS(area under the curve is 0.873, 95% confidence interval is 0.75-0.95). Thenext turn is MCTS, ACTP-SI, VCTP-SI, NIHSS, NCCT and CTA, there was a significant statisticalsignificance(P<0.05) for each parameter with CMCTS, except for the ACTP-SI(P=0.226) andNIHSS(/>=0.174).Conclusion The CMCTS based on NIHSS and multimodal CT is superior to NIHSS, MCTS,NCCT, CTA, and CTP in predicting clinical outcome in acute stroke.关键词
脑梗死/体层摄影术,X线计算机/灌流Key words
Brain infarction/ Tomography, x-ray computed/ Perfusion引用本文复制引用
王效春,高培毅,薛静,马丽..建立急性缺血性卒中的临床/多模式CT预后评分系统[J].中国卒中杂志,2012,7(3):178-184,7.基金项目
“十一五”国家科技支撑计划重点项目(2007BA105B07)北京市科技新星课题(2007B047) （2007BA105B07）
