应用CTA对基底节区大脑中动脉M1段急性梗死灶侧支循环建立情况的评价

Evaluation of Collateral Circulation Establishment in Acute Infarction Lesion of M1 Segment of Middle Cerebral Artery in Basal Ganglia Region Using CTA

摘要: 目的：探讨应用CT血管造影(CTA)对基底节区大脑中动脉M1段急性梗死灶侧支循环建立情况的评价效果。方法：选取本院2023年8月~2024年7月诊治的60例基底节区大脑中动脉M1段急性梗死患者，所有患者均行CTA检查与数字减影血管造影(DSA)检查评价侧支循环建立情况。以DSA检查结果为金标准，分析CTA对侧支循环建立情况评价的应用效能。分析不同侧支循环情况、不同侧支血管狭窄程度的CT参数[局部脑血流量(rCBF)、局部脑血容量(rCBV)、局部平均通过时间(rMTT)、局部最大峰值时间(rTTP)]与大脑中动脉区域侧支评分系统(Tan评分)的差异性。应用Pearson分析法，分析CT参数、Tan评分与侧支循环建立情况的相关性。对患者进行预后评估，分析不同侧支循环情况下神经功能缺损程度(NIHSS评分)、日常生活能力(BI评分)的差异性。结果：DSA检查评价为侧支循环不良27例，侧支循环良好33例；CTA检查评价为侧支循环不良25例，侧支循环良好35例；CTA对侧支循环建立情况评价的准确率、敏感度、特异度、阳性预测值、阴性预测值分别为86.67%、81.48%、90.91%、88.00%、85.71%。侧支循环良好组的rCBF、rCBV大于侧支循环不良组，rMTT、rTTP短于侧支循环不良组，Tan评分高于侧支循环不良组，均P < 0.05。不同侧支血管狭窄程度的rCBF、rCBV、rMTT、rTTP及Tan评分比较，均P < 0.05。侧支循环建立情况与rCBF、rCBV、Tan评分均呈正相关性(P < 0.05)，与rTTP呈负相关性(P < 0.05)，与rMTT无明显相关性(P > 0.05)。侧支循环良好组的NIHSS评分低于侧支循环不良组，BI评分高于侧支循环不良组，均P < 0.05。结论：CTA在基底节区大脑中动脉M1段急性梗死灶侧支循环建立情况评价中的应用效能较高，CT参数、Tan评分与侧支循环存在明显的相关性，侧支循环不良提示预后较差。

Abstract: Objective: To explore the evaluation effect of CT angiography (CTA) on the establishment of collateral circulation in acute infarction lesions of the M1 segment of the middle cerebral artery in the basal ganglia region. Method: Sixty patients with acute infarction of the M1 segment of the middle cerebral artery in the basal ganglia region treated in our hospital from August 2023 to July 2024 were selected. All patients underwent CTA and digital subtraction angiography (DSA) to evaluate the establishment of collateral circulation. Using DSA examination results as the gold standard, analyze the application effectiveness of CTA in evaluating the establishment of collateral circulation. Analyze the differences in CT parameters (rCBF, rCBV, rMTT, rTTP) and the middle cerebral artery regional collateral score system (Tan score) for different collateral circulation conditions and degrees of collateral vessel stenosis. Apply Pearson analysis to analyze the correlation between CT parameters, Tan score, and collateral circulation establishment. Evaluate the prognosis of patients and analyze the differences in the degree of neurological deficit (NIHSS score) and daily living ability (BI score) under different collateral circulation conditions. Result: DSA examination evaluated 27 cases of poor collateral circulation and 33 cases of good collateral circulation; CTA examination evaluated 25 cases of poor collateral circulation and 35 cases of good collateral circulation; The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CTA in evaluating the establishment of collateral circulation were 86.67%, 81.48%, 90.91%, 88.00%, and 85.71%, respectively. The rCBF and rCBV of the group with good collateral circulation were higher than those of the group with poor collateral circulation, while rMTT and rTTP were shorter than those of the group with poor collateral circulation. The Tan score was higher than that of the group with poor collateral circulation, all P < 0.05. The comparison of rCBF, rCBV, rMTT, rTTP, and Tan scores for different degrees of collateral vessel stenosis showed P < 0.05. The establishment of collateral circulation is positively correlated with rCBF, rCBV, and Tan scores (P < 0.05), negatively correlated with rTTP (P < 0.05), and not significantly correlated with rMTT (P > 0.05). The NIHSS score of the group with good collateral circulation was lower than that of the group with poor collateral circulation, and the BI score was higher than that of the group with poor collateral circulation, both P < 0.05. Conclusion: CTA has a high application efficiency in evaluating the establishment of collateral circulation in acute infarction of the M1 segment of the middle cerebral artery in the basal ganglia region. There is a significant correlation between CT parameters, Tan score, and collateral circulation, and poor collateral circulation indicates poor prognosis.