Application of CT cerebral perfusion in disease severity assessment and surgical planning for patients with large-area cerebral infarction

doi:10.3877/cma.j.issn.1673-9248.2025.02.008

Abstract

Abstract:

Objective

To explore the application value of CT cerebral perfusion imaging in assessing disease severity and guiding surgical planning for patients with large-area cerebral infarction.

Methods

A retrospective analysis was conducted on 126 patients with large-area cerebral infarction admitted to Xingtai Central Hospital from September 2021 to September 2023.All patients underwent CT cerebral perfusion imaging, and disease severity was evaluated using the National Institutes of Health stroke scale(NIHSS).Based on NIHSS scores, patients were categorized into mild (NIHSS score ≤ 4, 0 cases), moderate(NIHSS 5-20, 92 cases), and severe (NIHSS＞20, 34 cases) groups.CT perfusion imaging was analyzed for detecting infarct location and size, comparing cerebral perfusion parameters across different brain regions,assessing correlations between perfusion parameters and disease severity, and informing surgical decision-making.

Results

Among 126 patients, infarct locations included the basal ganglia (34.13%, 43 cases), frontal lobe(29.37%, 37 cases), temporal lobe (25.40%, 32 cases), occipital lobe (17.46%, 22 cases), and parietal lobe(4.76%, 6 cases).Infarct volumes were categorized as 10-15 cm³ (42.06%, 53 cases), ＞15-25 cm³ (37.30%,47 cases), and ＞25 cm³ (20.64%, 26 cases).Compared to healthy contralateral regions, both the infarct core and ischemic penumbra showed significantly lower cerebral blood flow (CBF) and cerebral blood volume(CBV), and higher time-to-peak (Tmax) and mean transit time (MTT) (all P＜0.05).The severe group exhibited lower CBF and CBV and higher Tmax and MTT in the infarct core than the moderate group (P＜0.05).Spearman correlation analysis revealed negative associations between CBF/CBV and disease severity(r=-0.419, P＜0.05; r=-0.522, P＜0.05) and positive association between Tmax/MTT and disease severity(r=0.356, P＜0.05; r=0.617, P＜0.05).Logistic regression identified CBF, CBV, Tmax, MTT, and infarct volume as independent predictors of disease severity (P＜0.05).Receiver operating characteristic curves demonstrated areas under the curve of 0.820 (CBF), 0.755 (CBV), 0.766 (Tmax), 0.842 (MTT), and 0.610(infarct volume) for severity assessment.All patients received medical treatment, with 94 undergoing arterial thrombolysis and 32 decompressive craniectomy.Postoperative survival was 94.44% (119/126), with 7 deaths and residual neurological sequelae in some survivors.

Conclusion

CT cerebral perfusion effectively identifies infarct location and vomule, evaluates disease severity, and provides critical insights for surgical planning in patients with large-area cerebral infarction.

Key words: CT cerebral perfusion, Large-area cerebral infarction, Severity of the disease, Surgical treatment plan

Jianlong Su, Wenjian Zhen, Yuting Sun, Jinmin Hao. Application of CT cerebral perfusion in disease severity assessment and surgical planning for patients with large-area cerebral infarction[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2025, 19(02): 133-140.

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Figures/Tables 7

References 24

1	Yi X, Zhou Q, Qing T, et al.20-hydroxyeiscosatetraenoic acid may be as a predictor of malignant middle cerebral artery infarction in patients with massive middle cerebral artery infarction [J].BMC Neurol, 2021,21(1): 437-446.
2	夏家杰, 姚斌, 郑刚, 等.耳后切口去骨瓣减压术治疗大面积脑梗死临床疗效 [J].中国神经精神疾病杂志, 2022, 48(9): 533-537.
3	Lu W, Jia D, Qin Y.Decompressive craniectomy combined with temporal pole resection in the treatment of massive cerebral infarction [J].BMC Neurol, 2022, 22(1): 167-175.
4	Jia F, Du CC, Liu XG.Delayed massive cerebral infarction after perioperative period of anterior cervical discectomy and fusion: a case report [J].World J Clin Cases, 2021, 9(28): 8602-8608.
5	Shahripour RB, Azarpazhooh MR, Akhuanzada H, et al.Transcranial Doppler to evaluate postreperfusion therapy following acute ischemic stroke: a literature review [J].J Neuroimaging, 2021, 31(5): 849-857.
6	中华医学会神经外科学分会, 国家卫健委脑卒中筛查与防治工程委员会, 海峡两岸医药卫生交流协会神经外科分会缺血性脑血管病学组.大面积脑梗死外科治疗指南 [J].中华医学杂志, 2021,101(45): 3700-3711.
7	Eskioglou E, Huchmandzadeh Millotte M, Amiguet M, et al.National Institutes of Health Stroke Scale Zero Strokes [J].Stroke, 2018,49(12): 3057-3059.
8	Chen J, Zou M, Zhang N, et al.New insight in massive cerebral infarction predictions after anterior circulation occlusion [J].Sci Rep,2023, 13(1): 23021-23043.
9	Yi X, Zhou Q, Qing T, et al.20-hydroxyeiscosatetraenoic acid may be as a predictor of malignant middle cerebral artery infarction in patients with massive middle cerebral artery infarction [J].BMC Neurol, 2021,21(1): 437-448.
10	Lu W, Jia D, Qin Y.Decompressive craniectomy combined with temporal pole resection in the treatment of massive cerebral infarction [J].BMC Neurol, 2022, 22(1): 167-179.
11	Li J, Zhao Y, Zhao M, et al.High variance of intraoperative blood pressure predicts early cerebral infarction after revascularization surgery in patients with Moyamoya disease [J].Neurosurg Rev, 2020,43(2): 759-769.
12	肖文, 张建军, 潘宁, 等.不同阶段大面积脑梗死头颅CT、MRI检查影像学征象及其预后评估价值 [J].中国CT和MRI杂志, 2022,20(8): 22-23, 34.
13	徐燕, 高阳.CTPI参数、sdLDL-C、Annexin A2、Hcy与急性脑梗死病情程度关联性及评估阿替普酶静脉效果价值 [J].影像科学与光化学, 2021, 39(5): 671-677.
14	Han H, Chen Y, Li R, et al.The value of early CT perfusion parameters for predicting delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis [J].Neurosurg Rev, 2022, 45(4): 2517-2531.
15	秦霜, 戴才文, 王根强, 等.CT灌注成像联合血清D-D、MMP-9对急性脑梗死患者溶栓后出血转化的预测价值研究 [J].中国CT和MRI杂志, 2023, 21(6): 24-27.
16	Klug J, Dirren E, Preti MG, et al.Integrating regional perfusion CT information to improve prediction of infarction after stroke [J].J Cereb Blood Flow Metab, 2021, 41(3): 502-510.
17	邹社昌, 凌容, 张泽微, 等.CTP参数与MCA重度狭窄或闭塞患者脑梗死病情的关系 [J].影像科学与光化学, 2022, 40(4): 741-745.
18	赵松, 张智琴, 刘岩, 等.全脑CT灌注成像诊断小体积急性脑梗死及其评估病灶体积与弥散加权成像的相关性 [J].中国医学影像技术,2022, 38(8): 1157-1161.
19	Klug J, Dirren E, Preti MG, et al.Integrating regional perfusion CT information to improve prediction of infarction after stroke [J].J Cereb Blood Flow Metab, 2021, 41(3): 502-510.
20	唐勇, 王远军.CT脑灌注成像定量分析在急性脑梗死早期诊断及手术指导中的临床价值研究 [J].中国CT和MRI杂志, 2021, 19(10):16-17, 86.
21	邓靖, 张鹤龄, 王源江, 等.双源CT颅脑灌注成像联合FGF21诊断脑梗死严重程度中的价值分析 [J].影像科学与光化学, 2022, 40(6):1444-1448.
22	Matsubara H, Imai T, Yamada T, et al.Importance of CBF measurement to exclude concomitant cerebral infarction in the murine endovascular perforation SAH model[J].J Stroke Cerebrovasc Dis,2020, 29(11): 105243-105253.
23	郭丽红, 陈辉, 张燕, 等.CT灌注成像联合血清microRNA-493预测急性脑梗死患者预后的价值[J].中国现代医学杂志, 2023, 33(22):88-93.
24	段鸿洲, 李良, 邱建星, 等.基于CT灌注成像的颅内外动脉旁路移植术在治疗缺血性脑血管病中的应用 [J].中国微创外科杂志, 2013,13(2): 110-115.

部位	CBF[ml/（100 g · min）]	CBV（ml/100 g）	Tmax（s）	MTT（s）
健侧区	49.64±7.29	3.37±0.73	8.93±1.34	4.81±1.03
缺血半暗带区	27.65±5.81^a	2.76±0.62^a	11.65±1.55^a	7.66±1.34^a
病灶区	10.27±2.46^ab	1.62±0.43^ab	14.62±1.89^ab	9.53±1.67^ab
F值	126.531	52.632	134.816	49.883
P值	＜0.001	＜0.001	＜0.001	＜0.001

部位	CBF[ml/（100 g · min）]	CBV（ml/100 g）	Tmax（s）	MTT（s）
健侧区	49.64±7.29	3.37±0.73	8.93±1.34	4.81±1.03
缺血半暗带区	27.65±5.81^a	2.76±0.62^a	11.65±1.55^a	7.66±1.34^a
病灶区	10.27±2.46^ab	1.62±0.43^ab	14.62±1.89^ab	9.53±1.67^ab
F值	126.531	52.632	134.816	49.883
P值	＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	CBF[ml/（100 g · min）]	CBV（ml/100 g）	Tmax（s）	MTT（s）
中度组	92	10.96±2.31	1.76±0.31	14.13±1.75	9.09±1.43
重度组	34	8.40±1.81	1.24±0.48	15.95±1.61	10.72±1.71
t 值		5.820	7.102	5.276	5.238
P值		＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	CBF[ml/（100 g · min）]	CBV（ml/100 g）	Tmax（s）	MTT（s）
中度组	92	10.96±2.31	1.76±0.31	14.13±1.75	9.09±1.43
重度组	34	8.40±1.81	1.24±0.48	15.95±1.61	10.72±1.71
t 值		5.820	7.102	5.276	5.238
P值		＜0.001	＜0.001	＜0.001	＜0.001

指标	例数	中度组（92 例）	重度组（34 例）	χ ²值	P值
性别				0.188	0.664
男	67	50（54.35）	17（50.00）
女	59	42（45.65）	17（50.00）
年龄				0.117	0.732
＜60 岁	86	62（67.39）	24（70.59）
≥ 60 岁	40	30（32.61）	10（29.41）
吸烟史				0.103	0.749
是	49	35（38.04）	14（41.18）
否	77	57（61.96）	20（58.82）
饮酒史				0.256	0.613
是	51	36（39.13）	15（44.12）
否	75	56（60.87）	19（55.88）
合并冠心病				0.775	0.379
是	66	46（50.00）	20（58.82）
否	60	46（50.00）	14（41.18）
合并高血压				0.054	0.817
是	72	52（56.52）	20（58.82）
否	54	40（43.48）	14（41.18）
合并糖尿病				0.605	0.437
是	81	61（66.30）	20（58.82）
否	45	31（33.70）	14（41.18）
入院延迟时间				5.039	0.025
＜3 h	86	68（73.91）	18（52.94）
≥ 3 h	40	24（26.09）	16（47.06）
起病状态				0.080	0.777
活动	79	57（61.96）	22（64.71）
静息	47	35（38.04）	12（35.29）
影像学受累范围				0.081	0.776
单侧	73	54（58.70）	19（55.88）
双侧	53	38（41.30）	15（44.12）
梗死体积				8.857	0.012
10～15 cm³	53	46（50.00）	7（20.59）
＞15～25 cm³	47	30（32.61）	17（50.00）
＞25 cm³	26	16（17.39）	10（29.41）

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