The evaluation value of CTP and CTA combined with serum NSE in collateral circulation status and prognosis of patients with post-stroke hemiplegia

doi:10.11958/20250127

Abstract

Abstract:

Objective To investigate the value of CT perfusion imaging (CTP) and CT angiography (CTA) combined with serum neuron-specific enolase (NSE) in assessing the status and prognosis of collateral circulation (CC) in hemiplegic patients with stroke. Methods A total of 106 patients with stroke hemiplegia were selected in this study. All patients underwent CTA and CTP, and patients were classified into the good CC group (n=67) and the poor CC group (n=39) based on CTA images. Patients were also classified into the good prognostic group (n=56) and the poor prognostic group (n=50) based on modified Rankin Scale (mRS) scores after 3 months of treatment. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum NSE levels. Pearson correlation analysis was used to analyse the correlation between CC scores and CTP parameters and serum NSE levels. The receiver operating characteristic (ROC) curve was used to analyze the evaluation value of serum NSE for the prognosis of hemiplegic patients after stroke. Kappa test was used to analyse the consistency of the prognosis and follow-up results of hemiplegic stroke patients assessed by CTP and CTA alone and in combination with serum NSE. Results The CTP parameters rCBF and rCBV were lower in the poor CC group than those in the good CC group (P<0.05), and levels of rTTP, rMTT and serum NSE were higher than those in the good CC group (P<0.01). CC score was positively correlated with rCBF and rCBV, and negatively correlated with rTTP, rMTT and serum NSE levels (P<0.05). The rCBF and rCBV were lower in the poor prognosis group than those in the good prognosis group, and the proportion of poor CC, rTTP, rMTT, serum NSE level and mRS score were higher than those in the good prognosis group (P<0.01). The area under the curve of serum NSE alone for predicting poor prognosis in hemiplegic patients with stroke was 0.878 (95%CI: 0.800-0.934), with a sensitivity of 74.00% and a specificity of 91.07%, which was in good agreement with the results of the follow-up (Kappa value=0.654, P<0.001). Conclusion CTP, CTA combined with serum NSE have a relatively high evaluation value for the assessment of the CC status and prognosis of stroke patients with hemiplegia.

Key words: tomography, X-ray computed, perfusion imaging, computed tomography angiography, stroke, hemiplegia, collateral circulation, prognosis

CLC Number:

R743.3

Figures/Tables 6

References 22

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组别			n		男性			年龄/岁				BMI/（kg/m²）
CC良好组			67		35（52.24）			57.76±7.59				22.14±1.32
CC不良组			39		21（53.85）			58.15±8.16				22.31±1.25
χ²或t					0.026			0.248				0.652
组别		吸烟史				高血压					糖尿病			冠心病
CC良好组		19（28.36）				33（49.25）					25（37.31）			16（23.88）
CC不良组		14（35.90）				20（51.28）					16（41.03）			13（33.33）
χ²		0.654				0.041					0.143			1.108
组别				高胆固醇血症					发病至入院时间
组别				高胆固醇血症					<4.5 h				4.5~6 h
CC良好组				14（20.90）					30（44.78）				37（55.22）
CC不良组				8（20.51）					15（38.46）				24（61.54）
χ²				0.002					0.402
组别	闭塞血管位置
组别	大脑中动脉						颈内动脉			大脑中动脉＋颈内动脉
CC良好组	38（56.72）						17（25.37）			12（17.91）
CC不良组	19（48.72）						12（30.77）			8（20.51）
χ²	0.644

组别			n		男性			年龄/岁				BMI/（kg/m²）
CC良好组			67		35（52.24）			57.76±7.59				22.14±1.32
CC不良组			39		21（53.85）			58.15±8.16				22.31±1.25
χ²或t					0.026			0.248				0.652
组别		吸烟史				高血压					糖尿病			冠心病
CC良好组		19（28.36）				33（49.25）					25（37.31）			16（23.88）
CC不良组		14（35.90）				20（51.28）					16（41.03）			13（33.33）
χ²		0.654				0.041					0.143			1.108
组别				高胆固醇血症					发病至入院时间
组别				高胆固醇血症					<4.5 h				4.5~6 h
CC良好组				14（20.90）					30（44.78）				37（55.22）
CC不良组				8（20.51）					15（38.46）				24（61.54）
χ²				0.002					0.402
组别	闭塞血管位置
组别	大脑中动脉						颈内动脉			大脑中动脉＋颈内动脉
CC良好组	38（56.72）						17（25.37）			12（17.91）
CC不良组	19（48.72）						12（30.77）			8（20.51）
χ²	0.644

组别	n	rCBF	rCBV	rTTP	rMTT	NSE/（μg/L）
CC良好组	67	0.68±0.16	1.27±0.32	0.91±0.21	1.93±0.45	28.12±7.01
CC不良组	39	0.49±0.13	0.89±0.24	1.18±0.23	2.45±0.56	43.68±10.37
t		6.300^＊＊	6.432^＊＊	6.163^＊＊	5.236^＊＊	9.202^＊＊

组别	n	rCBF	rCBV	rTTP	rMTT	NSE/（μg/L）
CC良好组	67	0.68±0.16	1.27±0.32	0.91±0.21	1.93±0.45	28.12±7.01
CC不良组	39	0.49±0.13	0.89±0.24	1.18±0.23	2.45±0.56	43.68±10.37
t		6.300^＊＊	6.432^＊＊	6.163^＊＊	5.236^＊＊	9.202^＊＊

组别	n		CC状态				NSE/ （μg/L）		mRS评分/ 分
组别	n		良好		不良		NSE/ （μg/L）		mRS评分/ 分
预后良好组	56		49（87.50）		7（12.50）		25.95±6.82		1.27±0.70
预后不良组	50		18（10.00）		32（90.00）		42.67±10.84		4.86±1.01
χ²或t			30.126^＊＊				9.610^＊＊		21.452^＊＊
组别		CTP参数
组别		rCBF		rCBV		rTTP		rMTT
预后良好组		0.69±0.15		1.34±0.36		0.87±0.19		1.85±0.43
预后不良组		0.51±0.10		0.89±0.25		1.16±0.24		2.44±0.52
t		7.178^＊＊		7.389^＊＊		6.932^＊＊		6.390^＊＊