平扫计算机体层成像值变化对急性脑梗死发病时间的预测价值

Value of the change in non-contrast computed tomography value in predicting the onset time of acute cerebral infarction

摘要:

目的 评估平扫计算机体层成像（CT）值变化（CT衰减率）对急性脑梗死发病时间的预测效能。方法 回顾性收集2021年3月—2025年3月长沙市第四医院收治的190例急性脑梗死患者的临床和影像学资料。根据急性脑梗死静脉溶栓时间窗将患者分为≤4.5 h组和＞4.5 h组，采用多因素Logistic回归分析筛选出急性脑梗死发病时间的影响因素，Spearman分析上述影响因素与急性脑梗死发病时间的相关性以及采用受试者操作特征（ROC）曲线分析上述影响因素对预测急性脑梗死发病时间的效能。结果 ≤ 4.5 h组患者患侧CT值、CT衰减率均高于＞4.5 h组（P<0.05）。患侧CT衰减率与急性脑梗死发病时间呈负相关性（r_s=-0.764, P<0.001）。CT衰减率预测急性脑梗死发病时间≤4.5 h的曲线下面积（AUC）为0.893（95%CI:0.848～0.938，P<0.001），最佳临界值为0.825（约登指数为0.645），灵敏度为89.70%，特异度为74.80%。结论 平扫CT衰减率对预测急性脑梗死发病时间是否在4.5 h内具有较高的诊断效能，可为临床判断患者是否符合静脉溶栓条件提供客观影像依据。

Abstract:

Objective To investigate the performance of the change in non-contrast computed tomography （CT） value （CT attenuation rate） in predicting the onset time of acute cerebral infarction （ACI）.Methods A retrospective analysis was performed for the clinical and imaging data of 190 ACI patients who were admitted to The Fourth Hospital of Changsha from March 2021 to March 2025， and according to the time window of intravenous thrombolysis for ACI， the patients were divided into ≤4.5 hours group and >4.5 hours group. A logistic regression analysis was used to identify the influencing factors for the onset time of ACI； a Spearman analysis was used to investigate the correlation between the above influencing factors and the onset time of ACI； a receiver operating characteristic （ROC） curve analysis was used to assess the performance of the above influencing factors in predicting the onset time of ACI.Results Compared with the >4.5 hours group， the ≤4.5 hours group had significantly higher CT value and CT attenuation rate of the affected side （P<0.05）. CT attenuation rate of the affected side was negatively correlated with the onset time of ACI （r_s=-0.764， P<0.001）. CT attenuation rate had an area under the ROC curve of 0.893 （95% confidence interval： 0.848-0.938， P<0.001） in predicting an ACI onset time of ≤4.5 hours， with an optimal cut-off value of 0.825 （Youden index=0.645）， a sensitivity of 89.70%， and a specificity of 74.80%.Conclusions Non-contrast CT attenuation rate has high diagnostic efficacy in predicting whether ACI onset time is within 4.5 hours， and it can provide an objective imaging basis for determining the eligibility of patients for intravenous thrombolysis in clinical practice.