MRI FLAIR序列血管高信号征对急性前循环脑梗死的临床评估作用  

Clinical evaluation of fluid attenuated inversion recovery vascular hyperintensity in acute anterior circulation infarction

作　　者：张卫 朱幼玲[2] 吴晓宇 朱双根[2] 翟登月[2] 

机构地区：[1]安徽省第二人民医院神经内科,合肥230000 [2]安徽医科大学第三附属医院(合肥市第一人民医院)神经内科,合肥230061

出　　处：《中华神经医学杂志》2015年第3期265-270,共6页Chinese Journal of Neuromedicine

基　　金：安徽省教育厅研究项目（KJ20132119）;安徽医科大学校科学研究基金（2013xkj048）

摘　　要：目的 探讨MRI液体衰减反转恢复（FLAIR）序列血管高信号征评估急性前循环脑梗死患者的血管狭窄程度和病情严重程度的可行性. 方法 选择自2013年5月至2014年5月连续入住安徽医科大学第三附属医院神经内科的急性前循环脑梗死患者340例,所有患者均完成相关MRI检查,包括磁共振扩散加权成像（DWI）、FLAIR及颈部、头颅磁共振血管成像（MRA）.根据FLAI序列血管高信号征出现与否将患者分为无血管高信号征组和有血管高信号征组,比较2组的基本临床资料、血管学指标及病情严重程度,应用受试者工作特征曲线（ROC）计算血管高信号征诊断血管严重狭窄和闭塞的灵敏度、特异度,分析血管高信号征对新TOAST分型中大动脉粥样硬化型急性脑梗死患者病情严重程度的评估价值. 结果 340例急性前循环脑梗死患者中有109例（32.1％）存在血管高信号征.在TOAST分型构成比及血管狭窄程度分级方面,无血管高信号征组和有血管高信号征组间差异存在统计学意义（P＜0.05）,其中有血管高信号征组以大动脉粥样硬化型所占比率最大（82.6％）,而无血管高信号征组以小血管病变型为主（56.3％）;有血管高信号征组血管严重狭窄及闭塞所占比率明显高于无血管高信号征组（34.9％vs 5.6％,39.5％vs 0.9％）,Spearman等级相关分析显示颈动脉-大脑中动脉血管狭窄程度与血管高信号征存在正相关关系（r=0.599,P=0.000）.与无血管高信号征组相比,有血管高信号征组的梗死体积更大,入院24h内美国国立卫生研究院卒中量表（NIHSS）评分更高,差异均有统计学意义（P＜0.05）.ROC曲线显示血管高信号征诊断血管严重狭窄的灵敏度为84.38％、特异度为88.52％[曲线下面积（AUC）=0.892,95％CI：0.85～0.94,P＜0.05],诊断血管闭塞的灵敏度为88.89％、特异度为85.76％（AUC=0.929,95％CI：0.89～0.97,P＜0.05）.在大动脉粥�Objective To evaluate whether MRI fluid attenuated inversion recovery （FLAIR）vascular hyperintensity （FVH） is an effective indicator for severe vascular stenosis or occlusion and disease severities in patients with acute anterior circulation infarction.Methods Three hundred and forty consecutive patients with acute anterior circulation infarction,admitted to our hospital from May 2013 to May 2014,were enrolled as subjects.All subjects were completed brain MR diffusion-weighted imaging （DWI）,FLAIR and neck vascular or brain magnetic resonance angiography （MRA）.According to the extent of FVH,all subjects were classified into negative FVH and positive FVH groups.Clinical data were obtained and compared among patients with different grades of FVH,and receiver operating characteristic （ROC） curve was used to calculate the sensitivity and specificity of FVH diagnosis of vascular severe stenosis or occlusion.The value of FVH in evaluating the disease severities of patients with large artery atherosclerosis combined with acute cerebral infarction according to new TOAST classification was evaluated.Results FVH was observed in 109 （32.06%） of the 340 patients.Significant differences were noted in the new TOAST classification ratio and vascular stenosis grading between the two groups; in the positive FVH group,the largest ratio was patients with large-artery atherosclerosis （82.6%）,while that was patients with small vessel diseases （56.3%）; the ratio of patients with severe vascular stenosis and occlusion in positive FVH patients was significantly higher than that in negative FVH patients （34.9% vs.5.6%,39.5% vs.0.9%）.Spearman rank correlation analysis indicated that the degrees of vascular stenosis of carotid artery-middle cerebral artery were positively correlated to FVH （r=0.599,P=0.000）.As compared with the negative FVH group,FVH patients had larger infarct volume and higher initial NIHSS scores （P〈0.05）.ROC curve indicated that FVH had a sensitivity of 84.38% and a specific

关 键 词：磁共振成像 液体衰减反转恢复序列 血管高信号征 脑梗死 急性 大动脉粥样硬化型 

分 类 号：R743.33[医药卫生—神经病学与精神病学]