Akūta insulta radioloģiskās pazīmes un insulta klīniskā iznākuma saistība ar ASPECTS skalu
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Date
2021
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Pētnieciskajā darbā “Akūta insulta radioloģiskās pazīmes un insulta klīniskā iznākuma saistība ar ASPECTS skalu” tiek apskatīts viens no mūsdienu biežākajiem pieaugušo populācijas invaliditātes un nāves cēloņiem. Akūts išēmisks insults ir cerebrovaskulāra saslimšana, kuras mērķtiecīgas un efektīvas terapijas nodrošināšanas stūrakmens ir ātra un objektīva diagnostika.
Pētnieciskā darba mērķis bija novērot un analizēt akūta insulta radioloģiskās pazīmes galvas CT izmeklējumā uzņemšanas un kontroles etapā, un analizēt Alberta stroke program early CT score (ASPECTS) novērtējuma saistību ar insulta klīnisko iznākumu.
Pētījumā tika iekļauti 63 akūta išēmiska insulta pacienti. Lai noteiktu radioloģiskās atrades, tajā skaitā ASPECTS novērtējuma saistību ar klīnisko iznākumu, tika veikta literatūras analīze par akūtu insultu, tā epidemioloģiju, etioloģiju, patofizioloģiju, radioloģisku un neiroloģisku novērtēšanu, izvērtēti kopumā 126 galvas smadzeņu bezkontrasta CT izmeklējumi, analizēti pacientu neiroloģisko novērtējumu rezultāti pēc Nacionālā veselības institūta insulta skala (NIHSS) un modificētā Rankina skala (mRS).
Analizējot 3 biežākās radioloģiskās pazīmes pirmreizējā izmeklējumā, ar nozīmīgu atrades biežumu novēroja tikai hiperdensas artērijas pazīmi (53,9%), bet insulārās rievas un bazālā ganglija pazīme raksturīgāk bija novērojama kontroles izmeklējumā, kur ar nelielu pārsvaru pār bazālā ganglija pazīmi (41,2%) dominēja insulārās rievas pazīme (47,6%). Pirmreizējā novērtējumā pēc ASPECTS rezultāts bija tuvu skalas maksimālajam punktu skaitam, taču atkārtotā novērtējumā vēroja samazināšanos par vidēji 2,67 (27,9%) punktiem.
Datu analīzē novēroja statistiski nozīmīgi sliktāku klīnisko iznākumu pacientiem ar pozitīvu hiperdensas artērijas (Whitney U tests, n= 63, u= 211.500, p<0.01), insulārās rievas pazīmi (Mann-Whitney U tests, n= 63, u= 255.500, p<0.01), bazālā ganglija pazīmi (Mann-Whitney U tests, n= 63, u= 178.000, p<0.01). Tāpat arī, ASPECTS skalas centrālo reģionu iesaiste insulta bojājuma perēklī norādīja uz augstāku NIHSS vērtību nekā perifēro reģionu bojājuma gadījumā gan pirmreizējā (Mann-Whitney U tests, n= 63, u= 168.500, p<0.001), gan atkārtotā (Mann-Whitney U tests, n= 63, u= 197.500, p<0.001) neiroloģiskā novērtējumā.
Pētījuma rezultāti norādīja uz saistību starp agrīnu insulta radioloģisko pazīmju pozitīvu atradi un sliktāku sagaidāmo klīnisko iznākumu. Tāpat arī, tika pierādīta saistība starp centrālo APSECTS reģionu bojājumu un sliktāku klīnisko iznākumu.
The research “Radiographic features of acute stroke and association between ASPECTS scale and clinical outcome” reviews one of the most common causes of disability and death in the adult population of modern society. Acute ischemic stroke is a cerebrovascular disease for which rapid and objective diagnostics is the cornerstone of effective treatment. The aim of the research was to identify and assess acute ischemic stroke radiographic signs on a CT scan of the head at the admission and on control basis, and to analyse the association between Alberta stroke program early CT score (ASPECTS) evaluation and clinical outcome. 63 acute ischemic stroke patients were included in the research. A literature review was done to analyse the clinical outcome based on radiographic findings and evaluation according to ASPECTS. Literature analysis reviewed the epidemiology, etiology, pathophysiology and the diagnostic imaging of stroke. A total of 126 non-contrast brain CT scans were assessed, and the results of patient neurological evaluation according to National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Score (mRS) scale were analysed. In the initial radiographic evaluation hyperdense middle cerebral artery sign showed a significant frequency of occurrence- 53,9% of case demonstrating positive findings. Insular ribbon and basal ganglia sign presence was higher in control basis radiographic evaluation, where insular ribbon (47,6%) sign showed a slight dominance over basal ganglia sign (41,2 %). In the initial evaluation the score obtained according to ASPECTS were close to the maximum possible, but on the control basis there was a decrease of points by 2.67 (27.9%) points on average. Clinical outcome (based on NIHSS score) difference between all study groups were statistically significant on follow-up scans: hyperdense MCA sign (Mann-Whitney U test, n= 63, u= 211.500, p<0.001); insular ribbon sign (Mann-Whitney U test, n= 63, u= 255.500, p<0.01) ; basal ganglia sign (Mann-Whitney U tests, n= 63, u= 178.000, p<0.01). Similarly, stroke lesion located in the central region group according to ASPECTS division indicated a worse clinical outcome compared to peripheral regions. Clinical outcome (based on NIHSS score) difference between ASPECTS region groups were statistically significant on initial (Mann-Whitney U tests, n= 63, u= 168.500, p<0.001) and on follow-up evaluation (Mann-Whitney U tests, n= 63, u= 197.500, p<0.001) The results of the study indicated that early radiographic stroke signs in a non-contract CT scan are associated with worse clinical outcome. Similarly, patients with lesion in ASPECTS central region is expected to demonstrate worse clinical outcome compared to peripheral regions.
The research “Radiographic features of acute stroke and association between ASPECTS scale and clinical outcome” reviews one of the most common causes of disability and death in the adult population of modern society. Acute ischemic stroke is a cerebrovascular disease for which rapid and objective diagnostics is the cornerstone of effective treatment. The aim of the research was to identify and assess acute ischemic stroke radiographic signs on a CT scan of the head at the admission and on control basis, and to analyse the association between Alberta stroke program early CT score (ASPECTS) evaluation and clinical outcome. 63 acute ischemic stroke patients were included in the research. A literature review was done to analyse the clinical outcome based on radiographic findings and evaluation according to ASPECTS. Literature analysis reviewed the epidemiology, etiology, pathophysiology and the diagnostic imaging of stroke. A total of 126 non-contrast brain CT scans were assessed, and the results of patient neurological evaluation according to National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Score (mRS) scale were analysed. In the initial radiographic evaluation hyperdense middle cerebral artery sign showed a significant frequency of occurrence- 53,9% of case demonstrating positive findings. Insular ribbon and basal ganglia sign presence was higher in control basis radiographic evaluation, where insular ribbon (47,6%) sign showed a slight dominance over basal ganglia sign (41,2 %). In the initial evaluation the score obtained according to ASPECTS were close to the maximum possible, but on the control basis there was a decrease of points by 2.67 (27.9%) points on average. Clinical outcome (based on NIHSS score) difference between all study groups were statistically significant on follow-up scans: hyperdense MCA sign (Mann-Whitney U test, n= 63, u= 211.500, p<0.001); insular ribbon sign (Mann-Whitney U test, n= 63, u= 255.500, p<0.01) ; basal ganglia sign (Mann-Whitney U tests, n= 63, u= 178.000, p<0.01). Similarly, stroke lesion located in the central region group according to ASPECTS division indicated a worse clinical outcome compared to peripheral regions. Clinical outcome (based on NIHSS score) difference between ASPECTS region groups were statistically significant on initial (Mann-Whitney U tests, n= 63, u= 168.500, p<0.001) and on follow-up evaluation (Mann-Whitney U tests, n= 63, u= 197.500, p<0.001) The results of the study indicated that early radiographic stroke signs in a non-contract CT scan are associated with worse clinical outcome. Similarly, patients with lesion in ASPECTS central region is expected to demonstrate worse clinical outcome compared to peripheral regions.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Išēmisks insults, insulta klīniskais iznākums, neiroradioloģija, natīvs datortomogrāfijas izmeklējums, Alberta Stroke Program Early CT Score, Ischemic stroke, clinical outcome of stroke, neuroimaging, non-contrast computed tomography, Alberta Stroke Program Early CT Score