醒后卒中缺血核心评估：自动CT灌注可靠吗？
本研究回顾性纳入117例醒后卒中伴大血管闭塞患者，以随访CT为参考标准，比较平扫CT ASPECTS与CTP rCBF ASPECTS对急性缺血核心的评估效能。结果显示rCBF ASPECTS与随访CT ASPECTS相关系数为0.68，低于平扫CT ASPECTS的0.85（P<0.05），38%的病例CTP低估缺血核心，22%的病例CTP正常而平扫CT已显示明确缺血改变。
要点
- 醒后卒中评估缺血核心时，CTP单独使用不可靠，22%病例CTP表现为正常（rCBF ASPECTS=10）而平扫CT已见明确缺血改变。
- 38%的病例rCBF ASPECTS相较CT ASPECTS低估缺血核心，评估取栓资格时需平扫CT与CTP联合判读。
- 延迟就诊可能是CTP低估已确立缺血改变的原因，需警惕rCBF假阴性。
核心结论
- CTP单独用于醒后卒中人群缺血核心评估不可靠，可能被低估。
- 考虑取栓资格时，平扫CT与CTP需结合仔细评估，因已确立的缺血改变在CTP上可被低估达38%的患者，可能归因于延迟就诊。
研究设计与样本
- 回顾性研究，连续纳入117例醒后卒中伴CTA证实大血管闭塞患者，其中女性55例，平均年龄75岁，范围32—90岁。
- 两名神经放射科医师以盲法共识方式回顾性评估初次CT和CTP（rCBF图）的ASPECTS评分，以随访CT作为参考标准。
关键影像表现/征象
- 44例（38%）rCBF ASPECTS相较CT ASPECTS低估了缺血核心。
- 44例中有26例（22%）CTP正常（rCBF ASPECTS=10分），而平扫CT显示明确的急性但已确立的缺血改变。
诊断标准与关键数值
- rCBF ASPECTS与随访CT ASPECTS的Pearson相关系数为0.68，低于平扫CT ASPECTS与随访CT ASPECTS的相关系数0.85（P<0.05）。
- CT ASPECTS与rCBF ASPECTS的一致性见于55例患者（47%）。
临床应用与阅片要点
- 醒后卒中评估取栓资格时不应仅依赖CTP的rCBF图，需将平扫CT ASPECTS与CTP结果联合判读。
- 当CTP显示正常但平扫CT已有明确低密度缺血改变时，应以平扫CT为准评估已确立的缺血核心。
局限性
- 本研究为回顾性设计，结果可能存在选择偏倚。
- 原始研究未报告多中心设计，样本来自单一连续队列，结论外推需谨慎。
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
AIM: Wake-up strokes represent up to 27% of all acute strokes. The main objective of this study was to assess the reliability of computed tomography perfusion (CTP) in the assessment of the acute ischaemic core in this population.
MATERIALS AND METHODS: Intracranial CT and CTP studies of 117 consecutive patients (55 female, mean age 75, range 32-90) presenting with wake-up strokes and large vessel occlusion on CT angiography were included. Studies were retrospectively reviewed by two neuroradiologists in consensus in a blinded manner to determine Alberta Stroke Programme Early CT Score (ASPECTS) score on the presenting CT and CTP (relative cerebral blood flow [rCBF] maps) studies, with follow-up CT acting as the reference standard.
RESULTS: Correlation between rCBF ASPECTS and follow-up CT ASPECTS (Pearson correlation coefficient 0.68) was less compared to plain CT ASPECTS and follow-up CT ASPECTS (Pearson correlation coefficient 0.85) (P < 0.05). There was concordance between CT ASPECTS and rCBF ASPECTS in 55 patients (47%). However, in 44 cases (38%), rCBF ASPECTS underestimated the ischaemic core compared to CT ASPECTS. Out of these 44 cases, in 26 cases (22%), the CTP was normal, with a rCBF ASPECTS score of 10, whilst CT showed clear acute but established ischaemic change.
CONCLUSION: This study shows that CTP alone is not reliable in the assessment of the ischaemic core in the wake-up stroke population. Both noncontrast CT and CTP need to be carefully assessed in conjunction when considering thrombectomy eligibility in this group as established ischaemic change may be underestimated by CTP in up to 38% of patients, likely due to the delayed presentation.
引用
- U-King-Im, Kallam, Chandra, et al. Automated computed tomography (CT) perfusion in the assessment of the ischaemic core in wake-up strokes: is it reliable? Clin Radiol. 2026. PMID: 42320317. doi:10.1016/j.crad.2026.107395
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。