基线NCCT与CTP判断急性缺血性卒中梗死核心的比较
约32.3%患者存在「NCCT-CTP不匹配」，其中35.9%取栓后预后良好；NCCT与随访影像在深部基底节区梗死相关性更强，但CTP可提供互补信息，建议两者联合应用。
要点
- 约三成AIS患者基线NCCT与CTP梗死核心评估不一致，需警惕。
- 「NCCT-CTP不匹配」患者中35.9%取栓后预后良好。
- NCCT对深部基底节区梗死与随访影像相关性优于CBF图。
核心结论
- 约30%患者存在「NCCT-CTP不匹配」，其中35.9%取栓后预后良好。
- NCCT与随访影像在深部基底节区梗死相关性更强，但CTP可提供互补信息，建议两者联合用于未来实践。
研究设计与样本
- 基线梗死核心体积定义为相对CBF低于对侧正常组织30%的区域。
- 「NCCT-CTP不匹配」定义为低ASPECTS（<6）伴小梗死核心（<70 ml）（LASC），或高ASPECTS（≥6）伴大梗死核心（≥70 ml）（HALC）。
关键影像表现/征象
- 「NCCT-CTP不匹配」见于145例（32.3%）患者，其中35.9%取栓后预后良好。
- LASC患者较HALC患者卒中发作时间更长（中位306 min vs. 125 min，P=0.004），取栓后出血性梗死发生率更高（33.1% vs. 8.3%，P=0.077）。
- 与CBF图相比，基线NCCT与随访影像在深部基底节区梗死相关性更强，早期和晚期就诊者均如此（均P<0.05）。
诊断标准与关键数值
- 基线梗死核心体积计算为相对CBF低于对侧正常组织30%的区域。
- 「NCCT-CTP不匹配」定义为低ASPECTS（<6）伴小梗死核心（<70 ml）（LASC），或高ASPECTS（≥6）伴大梗死核心（≥70 ml）（HALC）。
临床应用与阅片要点
- 阅片时需注意NCCT与CTP对梗死核心评估可能不一致，约三成患者存在不匹配。
- 对于LASC患者，需关注其发作时间较长及取栓后出血性梗死风险较高的特点。
- NCCT对深部基底节区梗死显示与随访影像相关性较好，可结合CTP互补评估。
局限性
- 回顾性研究设计。
- 单中心研究。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVES: To compare the value of noncontrast computed tomography (NCCT) and computed tomography perfusion (CTP) in determining the infarct core in patients with acute ischemic stroke (AIS).
METHODS: Four hundred and forty-nine AIS patients who underwent baseline NCCT and CTP assessment, endovascular thrombectomy (EVT) and follow-up imaging evaluation from October 2019 to August 2023 were retrospectively enrolled. Alberta Stroke Program Early Computed Tomography Score (ASPECTS) were assessed on baseline NCCT, cerebral blood flow (CBF) colored map and follow-up imaging. Baseline infarct core volume was calculated as regions with reduction in the relative CBF < 30% of that in contralateral normal tissue. "NCCT-CTP mismatch" was defined as low ASPECTS (< 6) with small infarct core (< 70 ml) (LASC), or high ASPECTS (≥ 6) with large infarct core (≥ 70 ml) (HALC).
RESULTS: "NCCT-CTP mismatch" was found in 145 (32.3%) patients, and 35.9% of them achieved good outcomes after EVT. IVT using before CTP imaging (OR, 1.833; P = 0.005) and higher admission NIHSS (OR, 1.055; P < 0.001) were independently associated with "NCCT-CTP mismatch". LASC patients exhibited longer stroke onset time [median, 306 min vs. 125 min; P = 0.004] and higher rate of hemorrhagic infarction (33.1% vs. 8.3%, P = 0.077) after EVT than HALC patients. Compared with CBF map, stronger correlations of deep basal ganglia regional infarct were found between baseline NCCT and follow-up imaging for both early and late presenters (all P < 0.05).
CONCLUSIONS: About 30% patients showed "NCCT-CTP mismatch", and 35.9% of them achieved good outcome. Despite NCCT showing stronger correlations, CTP could provide complementary information to NCCT, therefore both were suggested in future practice.
引用
- Chu Y, Zhang Q, Ma G, et al. Baseline imaging for determining infarct core in patients with acute ischemic stroke: noncontrast computed tomography vs computed tomography perfusion. Neuroradiology. 2026. PMID: 42118241. doi:10.1007/s00234-026-04021-9
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。