Efficacy of head and neck CT angiography combined with head CT perfusion imaging for assessing short-term prognosis in patients with acute ischemic stroke

doi:10.3877/cma.j.issn.1673-9248.2026.02.008

Abstract

Abstract:

Objective

To explore the efficacy of head and neck CT angiography (CTA) combined with cranial CT perfusion imaging (CTP) in the short-term prognosis of patients with acute ischemic stroke (AIS).

Methods

A total of 112 AIS patients from January 2022 to March 2024 at Xuzhou First People's Hospital were included. According to the modified Rankin scale (mRS) score 3 months after treatment, they were divided into a good prognosis group of 79 cases (mRS score ≤2) and a poor prognosis group of 33 cases (mRS score ＞2). Baseline data of all patients was collected. The characteristics of CTA and CTP were compared between the two groups using the Chi-square test and t-test. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of the two and their combination for the short-term prognosis of AIS patients.

Results

The patients in the good prognosis group showed significantly higher proportions of mild cerebral vascular stenosis (20.25% vs 9.09%, χ²=14.961, P=0.002), cerebral blood flow [CBF; (14.47±4.31) mL/(100 g·min) vs (8.39±2.66) mL/(100 g·min), t=7.516, P<0.001], cerebral blood volume [CBV; (15.81±3.62) mL/100 g vs (7.24±2.59) mL/100 g, t=12.331, P<0.001], and mean transit time [MTT; (16.97±3.38) s vs (15.02±2.14) s, t=3.063, P=0.003] compared to those in the poor prognosis group. Conversely, the stenosis degree of the most narrowed vessel in the good prognosis group was significantly lower than that in the poor prognosis group, with statistically significant difference [(57.91±4.88)% vs (63.84±3.76)%, t=6.243, P＜0.001]. Multivariate Logistic regression analysis showed that cerebral vascular stenosis/occlusion (OR=6.122, 95%CI: 1.718 - 21.819), the stenosis degree of the narrowest vessel (OR=1.423, 95%CI: 1.228 - 1.648), and CBF (OR=0.454, 95%CI: 0.248 - 0.830), CBV (OR=0.155, 95%CI: 0.038 - 0.629), and MTT (OR=0.742, 95%CI: 0.606 - 0.909) were all influencing factors for the poor short-term prognosis of AIS patients (all P＜0.05). The area under the ROC curve of head and neck CTA combined with cranial CTP for poor short-term prognosis in AIS patients was 0.907, with a sensitivity of 89.70% and a specificity of 95.50%.

Conclusion

The combined detection of head and neck CTA and cranial CTP in the skull can be used to evaluate the short-term prognosis of AIS patients and has certain predictive efficacy.

Key words: Acute ischemic stroke, CT angiography, CT perfusion imaging, Short-term prognosis

Ziheng Shan, Fan Wang, Li Ma, Tao Zhang, Li Shao. Efficacy of head and neck CT angiography combined with head CT perfusion imaging for assessing short-term prognosis in patients with acute ischemic stroke[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2026, 20(02): 164-169.

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URL: https://zhnxgbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1673-9248.2026.02.008

https://zhnxgbzz.cma-cmc.com.cn/EN/Y2026/V20/I02/164

Figures/Tables 5

项目	预后良好组（n=79）	预后不良组（n=33）	统计值	P值
性别[例（%）]			χ²=0.055	0.814
男	45（56.96）	18（54.55）
女	34（43.04）	15（45.45）
年龄（岁， $x ¯$ ±s）	64.57±6.14	65.13±6.09	t=0.441	0.660
发病至入院时间（h， $x ¯$ ±s）	2.21±0.49	2.16±0.53	t=0.481	0.632
基础疾病[例（%）]			χ²=0.164	0.685
高血压	44（55.70）	17（51.52）
糖尿病	35（44.30）	14（42.42）
高血脂	26（32.91）	10（30.30）
脑血管狭窄/闭塞[例（%）]			χ²=14.961	0.002
无狭窄	14（17.72）	0（0）
轻度狭窄	16（20.25）	3（9.09）
中度狭窄	21（26.58）	6（18.18）
重度狭窄	17（21.52）	12（36.36）
闭塞	11（13.92）	12（36.36）
最狭窄血管狭窄程度（%， $x ¯$ ±s）	57.91±4.88	63.84±3.76	t=6.243	＜0.001
CBF[mL/（100 g·min）， $x ¯$ ±s]	14.47±4.31	8.39±2.66	t=7.516	＜0.001
CBV（mL/100 g， $x ¯$ ±s）	15.81±3.62	7.24±2.59	t=12.331	＜0.001
MTT（s， $x ¯$ ±s）	16.97±3.38	15.02±2.14	t=3.063	0.003

项目	预后良好组（n=79）	预后不良组（n=33）	统计值	P值
性别[例（%）]			χ²=0.055	0.814
男	45（56.96）	18（54.55）
女	34（43.04）	15（45.45）
年龄（岁， $x ¯$ ±s）	64.57±6.14	65.13±6.09	t=0.441	0.660
发病至入院时间（h， $x ¯$ ±s）	2.21±0.49	2.16±0.53	t=0.481	0.632
基础疾病[例（%）]			χ²=0.164	0.685
高血压	44（55.70）	17（51.52）
糖尿病	35（44.30）	14（42.42）
高血脂	26（32.91）	10（30.30）
脑血管狭窄/闭塞[例（%）]			χ²=14.961	0.002
无狭窄	14（17.72）	0（0）
轻度狭窄	16（20.25）	3（9.09）
中度狭窄	21（26.58）	6（18.18）
重度狭窄	17（21.52）	12（36.36）
闭塞	11（13.92）	12（36.36）
最狭窄血管狭窄程度（%， $x ¯$ ±s）	57.91±4.88	63.84±3.76	t=6.243	＜0.001
CBF[mL/（100 g·min）， $x ¯$ ±s]	14.47±4.31	8.39±2.66	t=7.516	＜0.001
CBV（mL/100 g， $x ¯$ ±s）	15.81±3.62	7.24±2.59	t=12.331	＜0.001
MTT（s， $x ¯$ ±s）	16.97±3.38	15.02±2.14	t=3.063	0.003

指标	β值	SE值	Wald χ²值	P值	OR值	95%CI
脑血管狭窄/闭塞	1.812	0.648	7.810	0.005	6.122	1.718~21.819
最狭窄血管狭窄程度	0.352	0.075	21.988	＜0.001	1.423	1.228~1.648
CBF	-0.789	0.308	6.579	0.010	0.454	0.248~0.830
CBV	-1.863	0.714	6.802	0.009	0.155	0.038~0.629
MTT	-0.298	0.103	8.343	0.004	0.742	0.606~0.909
常量	-17.610	4.582	14.772	＜0.001	＜0.001	-

指标	AUC	标准误	P值	最佳截断值	95%CI	敏感度（%）	特异度（%）	约登指数
脑血管狭窄/闭塞	0.644	0.053	0.016	-	0.540~0.749	54.00	72.50	0.265
最狭窄血管狭窄程度	0.847	0.039	＜0.001	60.49 %	0.771~0.923	76.70	92.40	0.691
CBF	0.875	0.034	＜0.001	10.72 mL/（100 g·min）	0.808~0.941	86.00	81.20	0.782
CBV	0.757	0.059	0.006	11.57 mL/100 g	0.642~0.872	70.00	87.00	0.570
MTT	0.687	0.051	0.002	16.76 s	0.578~0.787	62.00	71.20	0.332
头颈部CTA联合头颅CTP	0.907	0.037	＜0.001	-	0.834~0.979	89.70	95.50	0.851

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