CTA-APCIIS联合CTP-ASPECTS评估急性 前循环卒中预后的价值

The Value of Combined CTA-APCIIS and CTP-ASPECTS in Evaluating Prognosis of Acute Anterior Circulation Stroke

摘要: 目的：本研究旨在探讨并验证将CT血管成像(CTA)衍生的APCIIS评分与CT灌注成像(CTP)衍生的ASPECTS评分相结合进行联合评估的方法，在预测急性前循环缺血性卒中(AIS)患者90天功能预后中的临床应用价值。方法：采用回顾性队列研究设计，连续纳入发病24小时内完成一站式CTA/CTP检查的前循环大血管闭塞性AIS患者。评估指标包括基于CTA的改良血栓负荷评分(APCIIS)、基于CTP的核心梗死范围评分(CTP-ASPECTS)。收集患者90天改良Rankin量表(mRS)评分，并依据mRS ≤ 2与mRS > 2分为预后良好组与预后不良组。采用单因素及多因素Logistic回归分析筛选预后独立预测因素。通过受试者工作特征(ROC)曲线评估各单一评分及将多个影像学参数纳入Logistic回归模型后所得综合预测概率对不良预后的预测效能，并比较其曲线下面积(AUC)。结果：共纳入90例患者，其中预后良好69例(76.7%)，预后不良21例(23.3%)。单因素分析显示，预后不良组患者基线美国国立卫生研究院卒中量表(NIHSS)评分、CTA-APCIIS评分显著更高，而CTP-ASPECTS评分显著更低(均P < 0.05)。多因素Logistic回归分析显示，在校正基线NIHSS评分后，较高的CTA-APCIIS评分(OR = 1.32, 95% CI: 1.05~1.66)与较低的CTP-ASPECTS评分(OR = 0.76, 95% CI: 0.59~0.98)是预后不良的独立危险因素。ROC曲线分析显示，联合了CTA-APCIIS与CTP-ASPECTS评分的多因素模型，其预测90天不良预后的AUC为0.927 (95% CI: 0.867~0.987)，预测效能显著高于单一的CTA评分(AUC = 0.845)或单一的CTP-ASPECTS评分(AUC = 0.883)。结论：基于多模态CTA/CTP构建的侧支循环的多参数联合评估模型，整合了血管闭塞负荷、核心梗死范围及侧支循环状态信息，在预测急性前循环AIS患者预后方面，较任何单一影像学评分具有更高的预测效能，为临床提供了一个更全面、精准的预后评估策略。

Abstract: Objective: This study aimed to explore and validate the clinical utility of a combined assessment model integrating the APCIIS score derived from CT angiography (CTA) and the ASPECTS score derived from CT perfusion (CTP) in predicting 90-day functional outcomes for patients with acute anterior circulation ischemic stroke (AIS). Methods: A retrospective cohort study was designed, consecutively enrolling AIS patients with large vessel occlusion in the anterior circulation who underwent one-stop CTA/CTP examination within 24 hours of onset. Evaluation metrics included the modified thrombus burden score (APCIIS) based on CTA and the core infarction extent score (CTP-ASPECTS) based on CTP. The 90-day modified Rankin Scale (mRS) scores were collected, and patients were categorized into favorable (mRS ≤ 2) and unfavorable (mRS > 2) outcome groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of prognosis. The predictive efficacy of individual scores and the comprehensive probability derived from a logistic regression model incorporating multiple imaging parameters for unfavorable outcomes were evaluated using receiver operating characteristic (ROC) curves, and their areas under the curve (AUC) were compared. Results: A total of 90 patients were included, comprising 69 (76.7%) with favorable outcomes and 21 (23.3%) with unfavorable outcomes. Univariate analysis revealed that patients in the unfavorable outcome group had significantly higher baseline National Institutes of Health Stroke Scale (NIHSS) scores and CTA-APCIIS scores, while their CTP-ASPECTS scores were significantly lower (all P < 0.05). Multivariate logistic regression analysis demonstrated that, after adjusting for baseline NIHSS scores, a higher CTA-APCIIS score (OR = 1.32, 95% CI: 1.05~1.66) and a lower CTP-ASPECTS score (OR = 0.76, 95% CI: 0.59~0.98) were independent risk factors for unfavorable outcomes. ROC curve analysis showed that the multivariate model combining CTA-APCIIS and CTP-ASPECTS scores achieved an AUC of 0.927 (95% CI: 0.867~0.987) for predicting 90-day unfavorable outcomes. This predictive performance was significantly superior to that of the CTA-APCIIS score alone (AUC = 0.845) or the CTP-ASPECTS score alone (AUC = 0.883). Conclusion: The multiparameter combined assessment model based on multimodal CTA/CTP, integrating information on vascular occlusion burden, core infarction extent, and collateral circulation status, exhibits superior predictive efficacy for the prognosis of acute anterior circulation AIS patients compared to any single imaging score. This approach offers a more comprehensive and precise strategy for clinical prognosis evaluation.