{"title":"脑ct灌注有助于心脏手术后疑似缺血性脑疾病患者神经预后的早期预测。","authors":"Hua Liu, Ming-Hao Luo, Jing-Chao Luo, Xiao-Mei Yang, Guo-Guang Ma, Chun-Sheng Wang, Chun-Jiu Zhong, Guo-Wei Tu, Zhe Luo","doi":"10.1053/j.jvca.2025.01.017","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to investigate the value of brain computed tomography perfusion (CTP) imaging in predicting neurological outcomes early in patients with suspected ischemic cerebral events after cardiac surgery.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>A university teaching hospital.</p><p><strong>Participants: </strong>Patients presenting with postoperative neurological symptoms suspected of ischemic stroke following cardiac surgery from June 2020 to January 2024.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Non-contrast computed tomography (NCCT) scans at initial evaluation and follow-up were evaluated using the semiquantitative Alberta Stroke Programme Early CT Score (ASPECTS). On CTP images, the volume of time to maximum (Tmax) >6.0 seconds and volume of relative cerebral blood flow (rCBF) <30% were calculated. The primary outcome was severe disability, defined as a Modified Rankin Scale (mRs) score ≥4 at discharge. In total, 109 patients were included. The presence of volume of Tmax >6.0 seconds (R<sup>2</sup> = 0.05, p = 0.006) and volume of rCBF <30% (R<sup>2</sup> = 0.18, p < 0.001) positively correlated with mRs at discharge. The areas under the ROC curves for ASPECTS-1, volume of Tmax >6 seconds, and volume of rCBF <30% were 0.62 (95% CI: 0.52-0.71, p = 0.009), 0.67 (95% CI: 0.57-0.76, p < 0.001), and 0.73 (95% CI: 0.64-0.81, p < 0.001), respectively. The volume of rCBF <30% demonstrated the highest accuracy (0.76, 95% CI: 0.64-0.86, p < 0.001), and a similar accuracy was only achieved by the NCCT scan in the follow-up (0.79, 95% CI: 0.67-0.88, p < 0.001).</p><p><strong>Conclusions: </strong>In patients with suspected ischemic cerebral events after cardiac surgery, brain CTP, particularly the assessment of the volume of rCBF <30%, demonstrates accuracy in predicting severe neurological disability compared to the initial NCCT scan. CTP may serve as an early and reliable prognostic tool to guide clinical decision-making in these patients.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Brain Computed Tomography Perfusion Facilitates Early Prediction of Neurological Outcomes in Patients Suspected of Ischemic Cerebral Conditions after Cardiac Surgery.\",\"authors\":\"Hua Liu, Ming-Hao Luo, Jing-Chao Luo, Xiao-Mei Yang, Guo-Guang Ma, Chun-Sheng Wang, Chun-Jiu Zhong, Guo-Wei Tu, Zhe Luo\",\"doi\":\"10.1053/j.jvca.2025.01.017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>This study aimed to investigate the value of brain computed tomography perfusion (CTP) imaging in predicting neurological outcomes early in patients with suspected ischemic cerebral events after cardiac surgery.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>A university teaching hospital.</p><p><strong>Participants: </strong>Patients presenting with postoperative neurological symptoms suspected of ischemic stroke following cardiac surgery from June 2020 to January 2024.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Non-contrast computed tomography (NCCT) scans at initial evaluation and follow-up were evaluated using the semiquantitative Alberta Stroke Programme Early CT Score (ASPECTS). On CTP images, the volume of time to maximum (Tmax) >6.0 seconds and volume of relative cerebral blood flow (rCBF) <30% were calculated. The primary outcome was severe disability, defined as a Modified Rankin Scale (mRs) score ≥4 at discharge. In total, 109 patients were included. The presence of volume of Tmax >6.0 seconds (R<sup>2</sup> = 0.05, p = 0.006) and volume of rCBF <30% (R<sup>2</sup> = 0.18, p < 0.001) positively correlated with mRs at discharge. The areas under the ROC curves for ASPECTS-1, volume of Tmax >6 seconds, and volume of rCBF <30% were 0.62 (95% CI: 0.52-0.71, p = 0.009), 0.67 (95% CI: 0.57-0.76, p < 0.001), and 0.73 (95% CI: 0.64-0.81, p < 0.001), respectively. The volume of rCBF <30% demonstrated the highest accuracy (0.76, 95% CI: 0.64-0.86, p < 0.001), and a similar accuracy was only achieved by the NCCT scan in the follow-up (0.79, 95% CI: 0.67-0.88, p < 0.001).</p><p><strong>Conclusions: </strong>In patients with suspected ischemic cerebral events after cardiac surgery, brain CTP, particularly the assessment of the volume of rCBF <30%, demonstrates accuracy in predicting severe neurological disability compared to the initial NCCT scan. CTP may serve as an early and reliable prognostic tool to guide clinical decision-making in these patients.</p>\",\"PeriodicalId\":15176,\"journal\":{\"name\":\"Journal of cardiothoracic and vascular anesthesia\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-03-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of cardiothoracic and vascular anesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1053/j.jvca.2025.01.017\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of cardiothoracic and vascular anesthesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1053/j.jvca.2025.01.017","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：本研究旨在探讨脑ct灌注成像（CTP）对心脏手术后疑似缺血性脑事件患者早期神经预后的预测价值。设计：回顾性观察性研究。环境：大学教学医院。参与者：2020年6月至2024年1月心脏手术后出现疑似缺血性卒中的术后神经系统症状的患者。干预措施:没有。测量和主要结果：初始评估和随访时的非对比计算机断层扫描（NCCT）扫描使用半定量的阿尔伯塔卒中计划早期CT评分（ASPECTS）进行评估。在CTP图像上，到达最大时间（Tmax) >6.0 s，相对脑血流体积（rCBF） 6.0 s (R2 = 0.05, p = 0.006)， rcbf2体积= 0.18,p < 0.001）与出院时mRs呈正相关。结论：在疑似缺血性脑事件的心脏手术后患者，脑CTP，尤其是rCBF体积的评估
Brain Computed Tomography Perfusion Facilitates Early Prediction of Neurological Outcomes in Patients Suspected of Ischemic Cerebral Conditions after Cardiac Surgery.
Objectives: This study aimed to investigate the value of brain computed tomography perfusion (CTP) imaging in predicting neurological outcomes early in patients with suspected ischemic cerebral events after cardiac surgery.
Design: Retrospective observational study.
Setting: A university teaching hospital.
Participants: Patients presenting with postoperative neurological symptoms suspected of ischemic stroke following cardiac surgery from June 2020 to January 2024.
Interventions: None.
Measurements and main results: Non-contrast computed tomography (NCCT) scans at initial evaluation and follow-up were evaluated using the semiquantitative Alberta Stroke Programme Early CT Score (ASPECTS). On CTP images, the volume of time to maximum (Tmax) >6.0 seconds and volume of relative cerebral blood flow (rCBF) <30% were calculated. The primary outcome was severe disability, defined as a Modified Rankin Scale (mRs) score ≥4 at discharge. In total, 109 patients were included. The presence of volume of Tmax >6.0 seconds (R2 = 0.05, p = 0.006) and volume of rCBF <30% (R2 = 0.18, p < 0.001) positively correlated with mRs at discharge. The areas under the ROC curves for ASPECTS-1, volume of Tmax >6 seconds, and volume of rCBF <30% were 0.62 (95% CI: 0.52-0.71, p = 0.009), 0.67 (95% CI: 0.57-0.76, p < 0.001), and 0.73 (95% CI: 0.64-0.81, p < 0.001), respectively. The volume of rCBF <30% demonstrated the highest accuracy (0.76, 95% CI: 0.64-0.86, p < 0.001), and a similar accuracy was only achieved by the NCCT scan in the follow-up (0.79, 95% CI: 0.67-0.88, p < 0.001).
Conclusions: In patients with suspected ischemic cerebral events after cardiac surgery, brain CTP, particularly the assessment of the volume of rCBF <30%, demonstrates accuracy in predicting severe neurological disability compared to the initial NCCT scan. CTP may serve as an early and reliable prognostic tool to guide clinical decision-making in these patients.
期刊介绍：
The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.
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