双期CTA血栓强化对于超急性期缺血性卒中患者血栓成分和来源的评估价值

doi:10.3969/j.issn.1674-8115.2026.06.007

摘要/Abstract

摘要：

目的·使用CT平扫（non-contrast computed tomography，NCCT）和双期CT血管造影（computed tomography angiography，CTA）评估不同亚型超急性期缺血性卒中患者血栓的强化情况。方法·回顾性分析2018年1月至2020年10月在上海交通大学医学院附属第六人民医院急诊神经内科就诊的超急性期缺血性卒中患者的临床资料，纳入大脑中动脉M1或M2段闭塞的患者。根据急性缺血性脑卒中TOAST（Trial of Org 10172 in Acute Stroke Treatment）分型标准对所有患者进行病因分型。分析这些患者在入院时及后续相关的临床及影像学资料，重点分析入院时的NCCT和CTA图像（n=113）以及机械取栓术后血栓的组织学检查情况（n=53）。计算各组血栓NCCT与CTA常规动脉期之间（Δ₁）、CTA动脉晚期之间（Δ₂）的CT值差异。通过ImageJ软件测量苏木精-伊红染色血栓中各成分的百分比，进一步分析各组间血栓成分的差异，并分析血栓相关CT值变化情况与血栓成分之间的相关性。结果·大动脉粥样硬化（large-artery atherosclerosis，LAA）型组的Δ₁值显著小于心源性组（P=0.001），心源性组和隐源性组间差异无统计学意义（P=0.840）。LAA组的Δ₂值显著大于隐源性组（P=0.035），心源性组和隐源性组间差异无统计学意义（P=0.691）。LAA组内血栓Δ₂值显著大于Δ₁值（P<0.001），另外2组组内差异均无统计学意义（均P>0.05）。LAA组患者血栓的红细胞比例显著高于心源性组和隐源性组（均P<0.05）。Δ₁值与血栓红细胞比例呈负相关（r=-0.511，P<0.001），与纤维蛋白/血小板比例呈正相关（r=0.502，P<0.001）。结论·入院NCCT和双期CTA的血栓强化有助于确定超急性期缺血性卒中患者的血栓来源。LAA型患者的血栓在常规动脉期出现强化，在动脉晚期强化程度更明显；心源性和隐源性患者的血栓在常规动脉期也出现强化，而动脉晚期强化程度与常规动脉期无差异。

关键词: 急性缺血性卒中, CT血管造影, 大动脉粥样硬化, 大脑中动脉, CT平扫

Abstract:

Objective ·To evaluate the enhancement of thrombi in patients with different subtypes of hyperacute ischemic stroke using pre-interventional non-contrast computed tomography (NCCT) and dual-phase computed tomography angiography (CTA). Methods ·From January 2018 to October 2020, the clinical data of patients with hyperacute ischemic stroke who presented to the Emergency Department of Neurology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively analyzed and the patients with hyperacute ischemic stroke caused by occlusion of the M1 or M2 segment of the middle cerebral artery were included. All patients were classified according to the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification criteria for acute ischemic stroke. The clinical and imaging data of these patients obtained at admission and during subsequent follow-up were analyzed, with particular emphasis on the initial NCCT and CTA images (n=113). Additionally, histological examinations of the retrieved thrombi were performed following mechanical thrombectomy (n=53). Differences in CT values were calculated between NCCT and conventional arterial-phase CTA (Δ₁), as well as between NCCT and late arterial-phase CTA (Δ₂). Percentages of each component on hematoxylin-eosin-stained sections were measured by ImageJ. The differences in thrombus composition among the groups and the correlation between CT value changes and thrombus composition were analyzed. Results ·The Δ₁ value in the large-artery atherosclerosis (LAA) group was lower than that in the cardioembolic group (P=0.001). No significant difference was found in the Δ₁value between the cardioembolic group and the cryptogenic group (P=0.840). The Δ₂ value in the LAA group was higher than that in the cryptogenic group (P=0.035). No significant difference was found in the Δ₂value between the cardioembolic group and the cryptogenic group (P=0.691). The Δ₂ value was significantly higher than the Δ₁ value in the LAA group (P<0.001). No significant differences were found between Δ₁and Δ₂ values in the cardioembolic group or the cryptogenic group (both P>0.05). The percentage of red blood cells in the thrombi from patients with LAA stroke was significantly higher than that in the cardioembolic group and the cryptogenic group (both P<0.05). The Δ₁ value was negatively correlated with the percentage of red blood cells (r=-0.511, P<0.001) and positively with the percentage of fibrin/platelet aggregates (r=0.502, P<0.001). Conclusion ·Thrombus enhancement on admission NCCT and dual-phase CTA can help identify the origin of thrombi in patients with hyperacute ischemic stroke. In the patients with LAA stroke, thrombi show enhancement in the conventional arterial phase with more prominent enhancement in the late arterial phase. In the patients with cardioembolic or cryptogenic stroke, thrombi also manifest enhancement in the conventional arterial phase, while the enhancement degree in the late arterial phase shows no difference from that in the conventional arterial phase.

Key words: acute ischemic stroke, computed tomography angiography (CTA), large-artery atherosclerosis (LAA), middle cerebral artery, non-contrast computed tomography (NCCT)

中图分类号:

R445.3

姚婷婷, 郭园园, 熊一嘉, 李跃华, 魏小二. 双期CTA血栓强化对于超急性期缺血性卒中患者血栓成分和来源的评估价值[J]. 上海交通大学学报（医学版）, 2026, 46(6): 751-758.

Yao Tingting, Guo Yuanyuan, Xiong Yijia, Li Yuehua, Wei Xiao′er. Thrombus enhancement on dual-phase CT angiography in the evaluation of thrombus composition and source in hyperacute ischemic stroke[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(6): 751-758.

图/表 6

图1 NCCT和双期CTA影像图片上ROI的划定示意图Note： On NCCT and biphasic CTA source images, three regions of interest (ROIs) were manually delineated within each thrombus. The CT values of the thrombus on NCCT and biphasic CTA images were calculated as the mean value of the three ROIs.

Fig 1 Schematic diagram of ROI delineation on NCCT and biphasic CTA images

图2 患者筛选流程及结果

Fig 2 Flowchart and results of patients screening

表1 患者的基线和相关临床资料

Tab 1 Baseline characteristics and relevant clinical data of patients

Characteristic	Stroke subtype			P value
Characteristic	LAA stroke (n=43)	Cardioembolic stroke (n=57)	Cryptogenic stroke (n=13)	P value
Male/n(%)	30 (69.8)	38 (66.7)	6 (46.2)	0.282
Age/year	73.7±8.2	76.0±8.4	74.5±6.1	0.360
Cardiovascular disease risk factor/n(%)
Smoking	20 (46.5)	20 (35.1)	4 (30.8)	0.415
Hypertension	33 (76.7)	40 (70.2)	7 (53.8)	0.279
Hyperlipidemia	9 (20.9)	20 (35.1)	4 (30.8)	0.302
Atrial fibrillation	10 (23.3)	41 (71.9)	7 (53.8)	<0.001
Diabetes	11 (25.6)	18 (31.6)	5 (38.5)	0.635
Time from symptom onset to CTA/min	265.6±44.4	250.4±41.7	250.0±40.4	0.184
NIHSS score at admission	10 (5, 14)	12 (7, 20)	11 (7.5, 15)	0.353
Hemorrhagic transformation/n(%)	8 (18.6)	14 (24.6)	4 (30.8)	0.609
mRS score after 3 months of onset	4 (2, 4)	4 (3, 6)	3 (1.5, 4.5)	0.015

图3 基于NCCT与双期CTA源图像间CT值的差异分析Note： ①P=0.001, ②P<0.001, ③P=0.035.

Fig 3 Analysis of differences in CT values between NCCT and dual-phase CTA source images

图4 基于血栓组织H-E染色的成分差异分析Note： ①P=0.009, ②P=0.034, ③P=0.035.

Fig 4 Analysis of differences in thrombus composition based on H-E staining

图5 血栓成分与NCCT和常规动脉期CTA的CT值差值（ Δ1 ）之间的相关性分析

Fig 5 Correlation analysis between thrombus composition and the difference in CT values between NCCT and conventional arterial-phase CTA (Δ1)

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