关键词: 脑梗死; 体层摄影术; X线计算机; 灌流

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 NIHSS score join multi-mode CT scoring system obtain clinical/multi-mode CT score. Finally, application of ROC curve analysis efficacy of each model predicting clinical outcome.Results The optimal threshold measured on CMCTS, MCTS, NCCT ASPECTS, arterial phase CTP-SI, venous phase ASPECTS, CTA TICI and NIHSS were>1, >1, >9, >6.5, >8.5, >1 and ≥7, respectively. The parameter that most accurately describes good clinical outcome 3 months after stroke is the CMCTS(area under the curve is 0.873, 95% confidence interval is 0.75-0.95). The next turn is MCTS, ACTP-SI, VCTP-SI, NIHSS, NCCT and CTA, there was a significant statistical significance(P<0.05) for each parameter with CMCTS, except for the ACTP-SI(P=0.226) and NIHSS(P=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.

Key words: Brain infarction; Tomography; x-ray computed; Perfusion