Abstract: Objective To investigate the predictive efficacy of CT perfusion imaging combined with multi-phase CT angiography for cerebral edema after mechanical thrombectomy in acute ischemic stroke due to large vessel occlusion(AIS-LVO). Methods A total of 80 patients with AIS-LVO patients who had completed mechanical thrombectomy treatment in the Binhu District of Hefei First People's Hospital from January 2019 to October 2023 were selected.All patients underwent CT perfusion imaging and multi-phase CT angiography diagnosis before operation, and relevant imaging data was collected.Based on the occurrence of cerebral edema within 72 hours after operation, the patients were divided into the occurrence group(n=26 cases) and the non occurrence group(n=54 cases).The predictive efficacy of CT perfusion imaging combined with multi-phase CT angiography for cerebral edema after mechanical thrombectomy for AIS-LVO was analyzed. Results The cerebral blood volume(CBV), cerebral blood flow(CBF), and multi temporal CT angiography scores of the occurrence group before thrombectomy were lower than those of the non occurrence group, and the mean transit time(MTT) and time to peak(TTP) were higher than those of the non occurrence group, with statistical significant differences(P＜0.05).Multivariate Logistic regression analysis showed that preoperative CT perfusion imaging parameters(CBV, CBF, MTT and TTP) and multi-temporal CT angiography scores of AIS-LVO patients were all influencing factors for postoperative cerebral edema(P<0.05).The receiver operating characteristic curve(ROC) was drawn.The results showed that the area under the curve(AUC) of CBF, MTT, TTP and multi-phase CT angiography for predicting cerebral edema after mechanical thrombectomy in AIS-LVO patients was >0.7, all of which had certain predictive value.The combined predictive AUC was 0.963, which had the best predictive value.The sensitivity of combined prediction was 96.20% and the specificity was 88.90%. Conclusion The preoperative CT perfusion imaging and multi-phase CT angiography related parameters of AIS-LVO mechanical thrombectomy have certain predictive value for the occurrence of postoperative cerebral edema in patients, and their combined predictive performance is the best.

Key words: Large vessel occlusion, Acute ischemic stroke, Mechanical thrombectomy, Cerebral edema, CT perfusion imaging, Multi-phase CT angiography

摘要： 目的 探讨CT灌注成像联合多时相CT血管成像对大血管闭塞急性缺血性脑卒中(AIS-LVO)机械取栓术后脑水肿的预测效能。方法 选取2019年1月~2023年10月期间在合肥市第一人民医院滨湖院区已完成机械取栓术治疗的80例AIS-LVO患者,所有患者在术前进行CT灌注成像、多时相CT血管成像诊断,并采集相关影像数据,依据患者术后72 h内脑水肿发生情况分为发生组(n=26例)与未发生组(n=54例),分析CT灌注成像联合多时相CT血管成像对AIS-LVO机械取栓术后脑水肿的预测效能。结果 发生组取栓术前脑血容量(CBV)、脑血流量(CBF)、多时相CT血管成像评分均低于未发生组,平均通过时间(MTT)、达峰时间(TTP)均高于未发生组,差异有统计学意义(P＜0.05);经多因素Logistic回归分析,结果显示,AIS-LVO患者机械取栓术前CT灌注成像参数(CBV、CBF、MTT及TTP)、多时相CT血管成像评分均是取栓术后脑水肿的影响因素(P＜0.05);绘制受试者工作特征曲线(ROC),结果显示,CBF、MTT、TTP、多时相CT血管成像对AIS-LVO患者机械取栓术后脑水肿预测的曲线下面积(AUC)均＞0.7,均有一定预测价值,联合预测AUC为0.963,预测价值最佳,联合预测的敏感度为96.20%、特异度为88.90%。结论 AIS-LVO机械取栓术前CT灌注成像、多时相CT血管成像相关参数均对患者术后脑水肿发生有一定预测价值,而其联合预测效能最佳。

关键词: 大血管闭塞, 急性缺血性脑卒中, 机械取栓术, 脑水肿, CT灌注成像, 多时相CT血管成像