FDG-PET/CT对急性脑血管病意识障碍患者脑功能评估的价值及其危险因素分析

张超; 叶玉平; 崔可; 王锦栋; 赵辉; 宋伟俊

doi:10.16766/j.cnki.issn.1674-4152.002275

FDG-PET/CT对急性脑血管病意识障碍患者脑功能评估的价值及其危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002275

浙江省台州医院重症医学科，浙江台州 317000

基金项目:

浙江省医药卫生科技计划项目 2019PY091

详细信息

通讯作者:
张超，E-mail：zh583211@163.com

中图分类号: R743.3 R814.42
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出版历程
- 收稿日期: 2021-03-12
- 网络出版日期: 2022-03-03

Value of FDG-PET/CT in the assessment of brain function and its risk factors in patients with acute cerebrovascular disease and consciousness disorder

Department of Severe Medicine, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang 317000, China

摘要

摘要: 目的探讨氟化脱氧葡萄糖(FDG)-PET/CT对急性脑血管病意识障碍患者脑功能评估的价值，并分析患者意识恢复情况的危险因素。方法选取2015年12月—2020年12月浙江省台州医院收治的急性脑血管病意识障碍患者170例作为研究对象，根据出院时修订版昏迷恢复量表(CRS-R)评分将其分为意识恢复组(73例)和意识未恢复组(97例)。收集临床资料，进行FDG-PET/CT检查，并测量左右侧不同感兴趣脑区标准摄取值(SUV)。采用ROC曲线分析不同感兴趣脑区SUV对患者意识恢复情况的评估价值，采用多因素logistic回归分析影响患者意识恢复情况的危险因素。结果意识未恢复组患者入院时CRS-R评分及顶叶、枕叶、颞叶、额叶、丘脑、小脑、基底节SUV明显低于意识恢复组(均P＜0.05)，脑积水构成比明显高于意识恢复组(P＜0.05)。意识未恢复组患者左右侧顶叶、枕叶、颞叶、额叶、丘脑、小脑、基底节SUV差异均无统计学意义(均P＞0.05)。不同感兴趣脑区SUV联合评估急性脑血管病患者意识恢复情况的曲线下面积大于顶叶、枕叶、颞叶、额叶、丘脑、小脑、基底节SUV单独检查(均P＜0.05)，其敏感度为96.90%，特异度为85.10%。顶叶、枕叶、颞叶、额叶、丘脑、小脑、基底节SUV均为急性脑血管病患者意识恢复的影响因素(均P＜0.05)。结论 FDG-PET/CT检查有利于评估急性脑血管病意识障碍患者脑功能情况。
- 急性脑血管病 /
- 氟化脱氧葡萄糖 /
- 正电子发射计算机断层显像 /
- 电子计算机X线断层扫描技术 /
- 意识障碍
Abstract: Objective To investigate the value of fluoride deoxyglucose (FDG)-PET/CT in the assessment of brain function in patients with acute cerebrovascular disease with consciousness disorder and analyse its risk factors. Methods A total of 170 patients with acute cerebrovascular disease and consciousness disorder, who were treated in our hospital from December 2015 to December 2020, were selected as the research objects, and they were divided into the consciousness recovery group (73 cases) and the unconsciousness group (97 cases) based on the scores of the Revised Coma Recovery Scale (CRS-R) at the time of discharge from the hospital. The clinical data were collected. FDG-PET/CT examination was performed, and the standard uptake values (SUVs) of different brain regions of interest on the left and right sides were measured. The ROC curve was used to analyse the evaluation value of SUV in different brain regions of interest for the recovery of consciousness in patients with acute cerebrovascular disease, and the multivariate Logistic regression model was used to analyse the risk factors affecting the recovery of consciousness. Results The CRS-R score and SUVs of the parietal lobe, occipital lobe, temporal lobe, frontal lobe, thalamus, cerebellum and basal ganglia in the unrecovered consciousness group were significantly lower than those in the recovered consciousness group (all P < 0.05), but the composition ratio of the hydrocephalus in the recovered consciousness group was significantly higher than that in the consciousness recovery group (P < 0.05). No statistically significant difference in SUVs of the parietal lobe, occipital lobe, temporal lobe, frontal lobe, thalamus, cerebellum and basal ganglia was found between the left and right brain of patients with the unconsciousness group (all P>0.05). The area under the curve of the combination of SUVs in different brain regions of interest in the assessment of the recovery of consciousness in patients with acute cerebrovascular disease was higher than that of SUV of the parietal lobe, occipital lobe, temporal lobe, frontal lobe, thalamus, cerebellum and basal ganglia alone (all P < 0.05). The sensitivity was 96.90%, and the specificity was 85.10%. The SUVs of the parietal lobe, occipital lobe, temporal lobe, frontal lobe, thalamus, cerebellum and basal ganglia were considered as risk factors affecting the recovery of consciousness in patients with acute cerebrovascular disease (all P < 0.05). Conclusion FDG-PET/CT examination is important to assess the brain function of patients with consciousness disorder and acute cerebrovascular disease.
- Acute cerebrovascular disease /
- Fluoride deoxyglucose /
- Positron emission computed tomography /
- Computed tomography /
- Consciousness disorder

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图 1 急性脑血管病意识未恢复患者左右侧不同感兴趣脑区SUV比较

注：左右侧不同感兴趣脑区SUV比较，均P>0.05。

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图 2 急性脑血管病意识未恢复患者FDG-PET/CT显像结果

注：A为左侧额叶，B为左侧丘脑，C为左侧小脑，D为左侧枕叶，E为右侧顶叶，F为右侧基底节，G为右侧颞叶。

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图 3 不同感兴趣脑区SUV评估急性脑血管病患者意识恢复情况的ROC曲线

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表 1 2组急性脑血管病意识障碍患者临床资料比较

组别	例数	性别(男/女, 例)	年龄(x±s, 岁)	病程(x±s, 月)	入院至PET/CT检查完成时间(x±s, h)	入院时CRS-R评分(x±s, 分)	高血压[例(%)]	感染[例(%)]
意识恢复组	73	38/35	56.94±18.08	3.44±1.02	10.72±2.88	8.37±2.12	32(43.84)	45(61.64)
意识未恢复组	97	54/43	57.85±18.61	3.67±1.09	11.15±3.04	6.68±1.67	51(52.58)	68(70.10)
统计量		0.219^a	0.319^b	1.400^b	0.934^b	5.814^b	1.274^a	1.337^a
P值		0.640	0.750	0.163	0.352	< 0.001	0.259	0.247

组别	例数	癫痫[例(%)]	脑积水[例(%)]	病灶部位[例(%)]				病灶直径(x±s, cm)
组别	例数	癫痫[例(%)]	脑积水[例(%)]	大脑	丘脑	小脑	基底节	病灶直径(x±s, cm)
意识恢复组	73	19(26.03)	24(32.88)	39(53.42)	11(15.07)	12(16.44)	11(15.07)	2.91±0.90
意识未恢复组	97	30(30.93)	49(50.52)	47(48.45)	20(20.62)	13(13.40)	17(17.53)	3.17±1.01
统计量		0.488^a	5.289^a	1.321^a				1.740^b
P值		0.485	0.021	0.724				0.084
注：^a为χ²值，^b为t值。

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表 2 2组急性脑血管病意识障碍患者不同感兴趣脑区SUV比较(x±s)

组别	例数	顶叶	枕叶	颞叶	额叶	丘脑	小脑	基底节
意识恢复组	73	6.81±1.72	5.90±1.49	6.54±1.66	5.37±1.35	6.42±1.63	5.28±1.34	6.46±1.64
意识未恢复组	97	4.05±1.05	3.72±0.95	3.83±0.97	3.60±0.92	3.79±1.01	3.50±0.89	3.88±1.04
t值		12.930	11.615	13.341	10.158	12.936	10.391	12.513
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

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表 3 不同感兴趣脑区SUV对急性脑血管病患者意识恢复情况的评估价值

项目	曲线下面积	最佳截断值	敏感度(%)	特异度(%)	P值	95%CI
顶叶SUV	0.867	5.19	86.10	75.10	< 0.001	0.813~0.922
枕叶SUV	0.808	4.52	79.30	65.10	< 0.001	0.745~0.871
颞叶SUV	0.833	4.93	83.80	70.90	< 0.001	0.773~0.894
额叶SUV	0.886	4.28	89.80	72.60	< 0.001	0.839~0.932
丘脑SUV	0.724	4.76	69.10	60.00	< 0.001	0.650~0.798
小脑SUV	0.763	4.01	72.70	63.60	< 0.001	0.694~0.832
基底节SUV	0.661	4.90	64.30	57.80	< 0.001	0.582~0.740
联合	0.955		96.90	85.10	< 0.001	0.929~0.981

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表 4 影响急性脑血管病患者意识恢复情况的危险因素分析

项目	B	SE	Wald χ²	P值	OR值	95% CI
入院时CRS-R评分	0.385	0.291	1.753	0.186	1.470	0.831~2.600
脑积水	0.124	0.205	0.366	0.545	1.132	0.757~1.692
顶叶SUV	0.652	0.216	9.121	0.003	1.920	1.257~2.932
枕叶SUV	0.695	0.189	13.508	< 0.001	2.003	1.383~2.901
颞叶SUV	0.500	0.224	4.974	0.026	1.648	1.062~2.556
额叶SUV	0.589	0.209	7.939	0.005	1.802	1.196~2.714
丘脑SUV	0.537	0.157	11.702	0.001	1.711	1.258~2.328
小脑SUV	0.654	0.184	12.629	< 0.001	1.923	1.341~2.758
基底节SUV	0.608	0.239	6.474	0.011	1.837	1.150~2.935

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