CT灌注成像联合MRA对缺血性脑卒中患者的诊断价值及预后预测价值分析

doi:10.3969/j.issn.1671-7171.2026.01.014

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摘要 【目的】 探讨CT灌注成像联合磁共振血管成像(MRA)对缺血性脑卒中(CIS)患者的临床诊断效能及预后预测价值。【方法】 回顾性分析2023年3月至2025年3月本院收治的92例疑似缺血性脑卒中患者的临床资料,根据数字减影血管造影(DSA)检查结果将患者分为CIS组(n=58)与非CIS组(n=34)。根据出院时改良Rankin量表(mRS)评分将CIS组患者分为预后良好组(n=21)和预后不良组(n=37)。比较上述患者的CT灌注成像参数[量化脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)]及MRA检查结果[最大密度投影(MIP)、多平面重组(MPR)]。采用受试者工作特征(ROC)曲线分析CT灌注成像联合MRA对缺血性脑卒中患者的诊断价值及预后的预测价值。【结果】 MRA诊断CIS的准确率为93.48%,灵敏度为93.10%,特异度为94.12%,误诊率为5.88%,漏诊率为6.90%,阳性预测值为0.964,阴性预测值为0.889,Kappa值为0.862。CIS组CBF、CBV均低于非CIS组,MTT、TTP均长于非CIS组,差异有统计学意义(P<0.05)。ROC曲线分析显示:联合诊断CIS价值最高,其曲线下面积(AUC)(95%CI)为0.925(0.874~0.977),灵敏度为84.5%,特异度94.1%;联合评估CIS预后的价值最高,其AUC(95%CI)为0.987(0.967~1.000),灵敏度为97.3%,特异度90.5%。【结论】 CT灌注成像联合MRA可提高CIS的诊断准确率及预后预测效能,值得临床借鉴。

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	李豪
	仝帅
	李昊泽

关键词 ：脑缺血, 卒中, 体层摄影术,螺旋计算机, 磁共振成像

Abstract：【Objective】 To explore the clinical diagnostic efficacy and prognostic predictive value of computed tomography(CT) perfusion imaging combined with magnetic resonance angiography(MRA) in patients with cerebral ischemic stroke(CIS). 【Methods】 The clinical data of 92 patients suspected of CIS admitted to our hospital from March 2023 to March 2025 were retrospectively analyzed. According to the results of digital subtraction angiography(DSA), the patients were divided into the CIS group(n=58) and the non-CIS group(n=34). The patients in the CIS group were further divided into the good prognosis group(n=21) and the poor prognosis group(n=37) based on the modified Rankin Scale(mRS) scores at discharge. The CT perfusion imaging parameters [cerebral blood flow(CBF), cerebral blood volume(CBV), mean transit time(MTT), time to peak(TTP)] and MRA findings [maximum intensity projection(MIP), multi-planar reconstruction(MPR)] of the above patients were compared. The receiver operating characteristic(ROC) curve was used to analyze the diagnostic and prognostic predictive value of CT perfusion imaging combined with MRA in patients with CIS. 【Results】 The diagnostic accuracy, sensitivity, and specificity of MRA for CIS were 93.48%, 93.10%, and 94.12%, respectively; the misdiagnosis rate was 5.88%, the missed diagnosis rate was 6.90%, the positive predictive value was 0.964, the negative predictive value was 0.889, and the Kappa value was 0.862. The levels of CBF and CBV in the CIS group were lower than those in the non-CIS group, while MTT and TTP were longer than those in the non-CIS group, with statistically significant differences(P<0.05). ROC curve analysis showed that the combined diagnosis had the highest value for CIS, with an area under the curve(AUC) [95% confidence interval(CI)] of 0.925(0.874-0.977), a sensitivity of 84.5%, and a specificity of 94.1%. Meanwhile, the combined assessment also presented the highest value for predicting the prognosis of CIS, with an AUC(95%CI) of 0.987(0.967-1.000), a sensitivity of 97.3%, and a specificity of 90.5%.【Conclusion】 CT perfusion imaging combined with MRA can significantly improve the diagnostic accuracy and prognostic predictive efficacy of ischemic stroke, which is worthy of clinical application and promotion.

Key words： Brain Ischemia Stroke Tomography, Spiral Computed Magnetic Resonance Imaging

收稿日期: 2025-07-04

中图分类号:

R743.3

引用本文:

李豪, 仝帅, 李昊泽. CT灌注成像联合MRA对缺血性脑卒中患者的诊断价值及预后预测价值分析[J]. 医学临床研究, 2026, 43(1): 52-55.
LI Hao, TONG Shuai, LI Haoze. Diagnostic and Prognostic Predictive Value of CT Perfusion Imaging Combined with MRA in Ischemic Stroke. JOURNAL OF CLINICAL RESEARCH, 2026, 43(1): 52-55.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2026.01.014 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2026/V43/I1/52

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