急性缺血性脑卒中病人FLAIR血管高信号与预后的相关性研究  

Fluid-attenuated inversion recovery vascular hyperintensities and acute ischemic stroke outcome

作　　者：荆利娜[1,2] 高培毅 林燕[1,3,2] 隋滨滨 陈丽[4] 

机构地区：[1]首都医科大学附属北京天坛医院放射科,北京100050 [2]磁共振成像脑信息学北京市重点实验室 [3]北京市神经外科研究所 [4]新疆和田地区人民医院放射科

出　　处：《国际医学放射学杂志》2017年第6期647-650,655,共5页International Journal of Medical Radiology

基　　金：“十二五”国家科技支撑计划项目(2011BAI08B09);国家自然科学基金(81301193);国家自然科学基金-NIH国际合作项目(81361120402);北京市自然科学基金(7162056,7133238)

摘　　要：目的探讨急性缺血性脑卒中病人液体衰减反转恢复(FLAIR)序列血管高信号(FHV)与临床预后是否有关。方法前瞻性纳入北京天坛医院2012年1月—2015年12月的急性缺血性脑卒中绿色通道病人39例,男25例,女14例,平均年龄(59.79±12.99)岁。病人均接受了基线MRI检查,包括扩散加权成像(DWI)、MR血管成像(MRA)和FLAIR,36例病人进行了7 d MRI随访,38例进行了90 d改良Rankin量表(m RS)评估。病人根据7 d MRA表现分为血管再通组与血管未再通组,根据90 d m RS评分分为结局良好组和结局不良组。评价基线FHV的分布范围及7 d复查FHV是否消失,采用Fisher精确检验分析比较7 d血管再通组与血管未再通组之间FHV消失的情况,结局良好组与结局不良组FHV分布范围。结果共评价36例病人7 d随访结果 ,其中血管再通组24例,血管未再通组12例。18例FHV消失,其中17例发生在血管再通组(17/24例,70.83%);1例发生在血管未再通组(1/12例,8.33%),差异有统计学意义(P<0.01)。共评价38例病人90 d m RS,其中结局良好组29例,结局不良组9例。2组间FHV分布层面、FHV ASPECTS评分差异均无统计学意义(P>0.05)。结论基线FHV的分布范围不能预测90 d临床预后是否良好,但是FHV消失意味着血管再通。Objective We investigated whether hyperintense vessels on fluid-attenuated inversion recovery（FLAIR）sequences are associated with stroke outcome. Method Thirty-nine patients with acute ischemic stroke in the emergency green channel in Tiantan Hospital were enrolled including 25 male patients and 14 female patients with the mean age of59.79±12.99 years. All the patients underwent MR examination including DWI, MRA and FLAIR at baseline, 36 completed followup MR examination at 7 days after stroke onset, and 38 cases completed Modified Rankin Scale（m RS） evaluation at 90 days. According to the MRA appearance at 7 days, patients were divided into two groups： vascular recanalization group and non-vascular recanalization group. According to the m RS at 90 days, patients were divided into two groups： good outcome group and bad outcome group. We assessed the presence of FLAIR hyperintense vessels（FHV） at the baseline and disappearance of FHV at 7 days. The presence of FHV at the baseline between good and bad outcome groups, the disappearance of FHV between vascular recanalization and non-vascular recanalization groups were compared respectively using Fisher ＇s exact test. Result Among the 36 cases who completed 7-day MRI followup, 24 cases presented vascular recanalization. Seventeen of the 18 cases（70.83%） who presented FHV disappearance were in the vascular recanalization group, and 1 of 12 case（8.33%） was in non-vascular recanalization group, showing significant difference（P〈0.01）. There were 38 cases under-went 90-days followup, 29 cases with good outcome and 9 cases with bad outcome. The number of slices showing FHV and modified Alberta Stroke Program Early CT Score（ASPECTS） of FHV at the baseline had no significant difference between good outcome group and bad outcome group（P〉0.05）. Conclusion The presence of FHV can not predict clinical outcome at90 days. However, FHV disappearance in cases with vascular recanalization can be considered as a marker for hemodynamic improvem

关 键 词：急性缺血性卒中 液体衰减反转恢复 磁共振成像 血管高信号 侧支循环 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.3[医药卫生—诊断学]