Value of cerebral CT perfusion imaging and event-related potential in assessment of cognitive dysfunction after stent implantation for symptomatic middle cerebral artery stenosis
Objective To investigate the application of cerebral CT perfusion imaging and event-related potential(ERP)in as-sessment of cognitive dysfunction after Neuroform EZ stent implantation in patients with symptomatic middle cerebral artery stenosis.Methods From January 2019 to October 2021,a total of 126 patients with symptomatic middle cerebral artery stenosis were enrolled,which included 94 males and 32 females,aged 41-61 years old with mean age of 51.18 years old;117 cases of Han nationality and 9 of others;18 cases of hypertension,20 of diabetes,16 of hyperlipidemia and 9 of atrial fib-rillation;33 cases of drinking history and 39 of smoking history;31 cases of junior high school and below,54 of secondary school or high school and 41 of college and above;body mass index was 21.60-28.50 kg/m2 with mean body mass index of 24.63 kg/m2;preoperative middle cerebral artery stenosis was 70％-80％in 61 cases and 81％-99％in 65;93 cases of collateral circulation pathway(73.81％);affected side was located on the left side in 73 cases and on the right side in 53.All of them underwent Neuroform EZ stent implantation and divided into cognitive dysfunction group(＜26 scores)and normal group(≥26 scores)by Montreal cognitive assessment scale.The cerebral CT perfusion imaging[time to peak(TTP),mean transit time(MTT),cerebral blood flow(CBF)and cerebral blood volume(CBV)]and ERP(P300 latency and amplitude)were compared be-tween 2 groups.The univariate and Logistic regression analysis were used to determine the influencing factors of cognitive impair-ment,and receiver operating characteristic(ROC)curve was used to evaluate diagnostic efficacy of cerebral CT perfusion imaging and ERP indicators for cognitive dysfunction.Results The operation of 126 patients were successful.Twelve-month post opera-tion,all patients were divided into cognitive dysfunction group(n=36)and normal group(n=90)according to Montreal cognitive assessment scale.There was no significant difference in age,nationality,hypertension,diabetes,hyperlipidemia,atrial fibrillation,drinking history,smoking history,education level,body mass index,preoperative middle cerebral artery stenosis,affected side and collateral circulation pathway between cognitive dysfunction group and normal group(x2/t=0.569,1.197,0.233,0.481,0.716,0.108,0.066,0.628,0.401,2.547,0.918,0.411,0.737,P=0.570,0.274,0.629,0.488,0.398,0.743,0.798,0.428,0.818,0.280,0.338,0.522,0.391;P＞0.05).The CBF in cognitive dysfunction group[(12.32±3.55)mL/(100 g·min)vs(22.42±2.47)mL/(100 g·min);t=15.625,P=0.000]and CBV[(0.81±0.21)mL/100 g vs(1.45±0.19)mL/100 g;t=16.571,P=0.000]were statistically significantly lower than those in normal group.The MTT in cognitive dysfunction group[(7.89±0.58)seconds vs(3.62±0.55)seconds;t=38.761,P=0.000]and TTP[(19.87±2.86)seconds vs(11.32±3.02)seconds;t=14.570,P=0.000]were significantly higher than those in normal group.Twelve-month post operation,the Montreal cognitive assessment scale score was positively correlated with CBF,CBV and P300 amplitude(r=0.422,0.838,0.794,P=0.000);Montreal cognitive assessment scale score was negatively correlated with MTT,TTP and P300 latency(r=-0.949,-0.823,-0.750,P=0.000).The Logistic re-gression analysis showed that CBF,CBV,MTT,TTP,P300 latency and P300 amplitude were the influencing factors of cognitive dysfunction(P＜0.05).ROC curve regression analysis(combined diagnosis)showed the largest AUC value of 0.895(95％confi-dence interval 0.827-0.979).Conclusion It is demonstrated that cerebral CT perfusion imaging and ERP indicators are abnor-mally expressed in patients with cognitive dysfunction after symptomatic middle cerebral artery stenosis,which are influencing factors of cognitive dysfunction,and could be applied to predict and evaluate the cognitive dysfunction.
CT perfusion imagingevent related potentialmiddle cerebral arteryNeuroform EZ stent implantationcognition impairmentinfluence factors
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