[1]雷文刚,刘晋斐,张安林,等.CTA、CTP参数及改良Fisher分级与动脉瘤性蛛网膜下腔出血后迟发性脑缺血关系研究[J].陕西医学杂志,2026,(8):1080-1085，1091.[doi:DOI:10.3969/j.issn.1000-7377.2026.08.011]
　LEI Wengang,LIU Jinfei,ZHANG Anlin,et al.Relationship between CTA,CTP parameters and modified Fisher grade and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage[J].,2026,(8):1080-1085，1091.[doi:DOI:10.3969/j.issn.1000-7377.2026.08.011]
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CTA、CTP参数及改良Fisher分级与动脉瘤性蛛网膜下腔出血后迟发性脑缺血关系研究

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2026年8期
页码:
1080-1085，1091
栏目:
临床研究
出版日期:
2026-08-05

文章信息/Info

Title:
Relationship between CTA,CTP parameters and modified Fisher grade and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage
作者:
雷文刚; 刘晋斐; 张安林; 倪邦勇; 李东
（攀枝花市第二人民医院，四川 攀枝花 617000）
Author(s):
LEI Wengang; LIU Jinfei; ZHANG Anlin; NI Bangyong; LI Dong
(The Second People’s Hospital of Panzhihua,Panzhihua 617000,China)
关键词:
动脉瘤性蛛网膜下腔出血; 迟发性脑缺血; CT血管造影; CT灌注成像; 改良Fisher分级; 预测价值
Keywords:
Aneurysmal subarachnoid hemorrhage; Delayed cerebral ischemia; CT angiography; CT perfusion; Modified Fisher grade; Predictive value
分类号:
R 743.35
DOI:
DOI:10.3969/j.issn.1000-7377.2026.08.011
文献标志码:
A
摘要:
目的：探讨入院时CT血管造影（CTA）、CT灌注成像（CTP）参数及改良Fisher分级与动脉瘤性蛛网膜下腔出血后迟发性脑缺血的关系。方法：选取接受血管内栓塞治疗的动脉瘤性蛛网膜下腔出血患者108例。根据术后30 d内是否发生迟发性脑缺血分为观察组（发生迟发性脑缺血，36例）和对照组（未发生迟发性脑缺血，72例）。比较两组入院时CTA、CTP参数及改良Fisher分级情况。绘制受试者工作特征（ROC）曲线或采用四格表法分析CTA、CTP参数及改良Fisher分级对动脉瘤性蛛网膜下腔出血后迟发性脑缺血的预测价值。结果：观察组和对照组性别、年龄、体重指数、动脉瘤位置及大小等比较差异无统计学意义（均P＞0.05）。观察组中重度脑血管痉挛比例高于对照组（P＜0.05）。观察组入院时相对脑血容量（rCBV）和相对脑血流量（rCBF）低于对照组，相对平均通过时间（rMTT）高于对照组（均P＜0.05）。观察组入院时改良Fisher分级Ⅲ级比例高于对照组（P＜0.05）。rCBF、rMTT、rCBV预测动脉瘤性蛛网膜下腔出血后迟发性脑缺血的曲线下面积（AUC）分别为0.834、0.741、0.643（均P＜0.05）。责任动脉脑血管痉挛程度、改良Fisher分级预测动脉瘤性蛛网膜下腔出血后迟发性脑缺血的敏感度分别为61.11%、63.89%，特异度为72.22%、61.11%，阳性预测值为52.38%、45.10%，阴性预测值为78.79%、77.78%（均P＜0.05）。责任动脉脑血管痉挛程度、rCBF及改良Fisher分级联合预测动脉瘤性蛛网膜下腔出血后迟发性脑缺血的AUC高于rCBF、rMTT、rCBV、责任动脉脑血管痉挛程度及改良Fisher分级单独预测的AUC（均P<0.05）。结论：入院时CTA、CTP参数及改良Fisher分级与动脉瘤性蛛网膜下腔出血后迟发性脑缺血有关，且责任动脉脑血管痉挛程度、rCBF联合改良Fisher分级对动脉瘤性蛛网膜下腔出血后迟发性脑缺血的预测效能较好。
Abstract:
Objective:To investigate the relationship between admission CT angiography (CTA),CT perfusion (CTP) parameters and modified Fisher grade and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.Methods:A total of 108 patients with aneurysmal subarachnoid hemorrhage who underwent endovascular embolization were selected.According to whether delayed cerebral ischemia occurred within 30 days after surgery,they were divided into observation group (with delayed cerebral ischemia,36 cases) and control group (without delayed cerebral ischemia,72 cases).The admission CTA,CTP parameters and modified Fisher grade were compared between the two groups.ROC curve was drawn or four-fold table method was used to analyze the predictive value of CTA,CTP parameters and modified Fisher grade for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.Results:There were no statistically significant differences in gender,age,body mass index,location and size of aneurysm between the observation group and the control group (all P>0.05).The proportion of severe cerebral vasospasm in the observation group was higher than that in the control group (P<0.05).The admission relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) in the observation group were lower than those in the control group,and the relative mean transit time (rMTT) was higher than that in the control group (all P<0.05).The proportion of modified Fisher grade Ⅲ on admission in the observation group was higher than that in the control group (P<0.05).The AUC of rCBF,rMTT and rCBV for predicting delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage were 0.834,0.741 and 0.643,respectively (all P<0.05).The sensitivity of the degree of responsible artery cerebral vasospasm and modified Fisher grade for predicting delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage was 61.11% and 63.89%,respectively,the specificity was 72.22% and 61.11%,the positive predictive value was 52.38% and 45.10%,and the negative predictive value was 78.79% and 77.78%,respectively (all P<0.05).The AUC of the combination of the degree of responsible artery cerebral vasospasm,rCBF and modified Fisher grade for predicting delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage was higher than the AUC of rCBF,rMTT,rCBV,the degree of responsible artery cerebral vasospasm and modified Fisher grade alone (all P<0.05).Conclusion:Admission CTA,CTP parameters and modified Fisher grade are correlated with delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage,and the combination of the degree of responsible artery cerebral vasospasm,rCBF and modified Fisher grade has favorable predictive efficacy for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.

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备注/Memo

备注/Memo:
四川省卫生健康委员会科研计划项目（2022SRC-12031）
更新日期/Last Update: 2026-08-13