摘要目的:探讨双层探测器光谱CTA区分急性缺血性脑卒中（acute ischemic stroke, AIS）患者梗死核心和半暗带的价值，进一步探究梗死核心的相关危险因素及其预测价值。方法:回顾性分析2022年3月至2023年5月苏州大学附属第二医院诊治的符合纳入标准的163例AIS患者的影像学及临床资料。将2022年3月至2022年12月的患者作为训练集，2023年1月至2023年5月的患者作为验证集进行内部验证。所有患者均接受双层探测器头颈部光谱CTA及颅脑CT灌注成像检查。以CTP为参照，按照脑组织低灌注区是否出现梗死核心将患者分为梗死核心组与无梗死核心组。通过多因素logistic回归分析筛选出梗死核心的独立影响因素，运用受试者工作特征（ROC）曲线分析相关风险因素对梗死核心的预测效能。结果:本研究共纳入163例AIS患者，其中训练集有112例，验证集有51例。训练集的两组患者在碘密度值、有效原子序数值、高血压、甘油三酯及中性粒细胞方面组间比较具有统计学意义（ P<0.05）。通过Prism软件测定碘密度值和有效原子序数值在梗死核心区和半暗带区的最佳截断值分别为0.215 mg/mL和7.405。多因素Logistic回归分析结果显示，碘密度值、高血压是AIS梗死核心的独立危险因素，甘油三酯是独立保护因素。碘密度值的ROC曲线下面积(AUC)最大（0.859），敏感度为70.27%，特异度为90.67%，具有较好的预测价值。验证集的ROC曲线分析结果与训练集一致。 结论:光谱CT参数碘密度值及有效原子序数值具有区分AIS患者梗死核心区和半暗带区的潜能。碘密度值、高血压是AIS梗死核心的独立危险因素，甘油三酯是独立保护因素，其中双层探测器光谱CT参数碘密度值具有较高的预测价值。

abstractsObjective:To investigate the value of dual-detector spectral CTA in distinguishing infarct core from penumbra in patients with acute ischemic stroke(AIS), and to further explore the risk factors associated with infarct core and their predictive value.Methods:The imaging and clinical data of 163 patients with AIS who met the inclusion criteria admitted to the Second Affiliated Hospital of Soochow University from March 2022 to May 2023 were retrospectively analyzed. Patients from March 2022 to December 2022 were used as the training group, and patients from January 2023 to May 2023 were used as the validation group for internal validation. The head and neck spectral CTA and brain CT perfusion imaging with dual-layer detector spectral CT were all carried out on all patients. Using CTP as reference, the patients were divided into infarct core group and non-infarct core group according to whether an infarct core occurred in the hypoperfusion regions of brain tissue. Multivariate logistic regression analysis was used to screen predictors related to the infarct core. The receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy.Results:A total of 163 patients were included in the study, including 112 in the training group and 51 in the validation group. There were significant differences in iodine density, effective atomic number, hypertension, triglyceride and neutrophils between the two groups ( P< 0.05). The cutoff values for iodine density values and effective atomic number values were 0.215 mg/mL and 7.405, respectively. Multivariate logistic regression analysis showed that iodine density and hypertension were independent risk factors for infarct core in AIS, and triglyceride was an independent protective factor. The area under the ROC curve (AUC) of iodine density value was the largest (0.859), with a sensitivity of 70.27%, and a specificity of 90.67%, which had a good predictive value. The ROC curve analysis results for the validation group were consistent with the training group. Conclusions:Spectral CT parameters iodine density values and effective atomic number values have the potential to distinguish the infarct core area from the penumbra area in patients with AIS. Iodine density and hypertension were independent risk factors of infarct core in AIS, triglyceride was an independent protective factor, and iodine density values obtained by dual-layer spectral detector CT had a high predictive value.