FLAIR血管高信号征预测急性缺血性脑卒中患者预后的应用价值  

To explore application value of FVHs in predicting the outcome of acute ischemic stroke

作　　者：耿文 姜亮[1] 陈慧铀 许权[1] 谢光辉[1] 殷信道[1] 周俊山[2] 张颖冬[2] GENG Wen;JIANG Liang;CHEN Hui-you;XU Quan;XIE Guang-hui;YIN Xindao;ZHOU Jun-shan;ZHANG Ying-dong(Department of Radiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China;Department of Neurology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)医学影像科,南京210006 [2]南京医科大学附属南京医院(南京市第一医院)神经内科,南京210006

出　　处：《磁共振成像》2018年第12期893-897,共5页Chinese Journal of Magnetic Resonance Imaging

基　　金：江苏省科技发展计划项目(编号:BE2017614)~~

摘　　要：目的通过对发病时间明确的急性缺血性脑卒中(acute ischemic stroke,AIS)患者头颅MRI的液体反转恢复(fluid-attenuated inversion-recovery,FLAIR)序列及数字减影血管造影(digital subtraction angiography,DSA)技术图像的分析,探讨FLAIR血管高信号征(FLAIR vascular hyperintensities,FVHs)预测急性缺血性脑卒中患者预后的应用价值。材料与方法选择发作时间在4.5 h之内的AIS患者,所有患者在入院时行MRI,包括FLAIR序列,所有患者均行溶栓治疗,并经MRI证实存在头颈部血管严重狭窄或闭塞在入院12 h内行介入取栓治疗。入组患者按发病3个月时改良Rankin量表(Modified Rankin Scale,mRS)评分分为两组:≤2分预后较好为A组,>2分预后较差为B组,计量资料以均数±标准差表示,组间比较采用独立样本t检验,计数资料用χ2检验,FVHs评分定义为ASPECTS评分的7个皮质区域(岛叶,M1～M6)每出现FLAIR血管高信号计1分,共计7分;侧枝循环级别评定遵照美国介入和治疗神经放射学会/介入放射学学会侧枝循环的评估系统:0级:没有侧枝血流到缺血区域;1级:缓慢的侧枝血流到缺血周边区域,伴持续的灌注缺陷;2级:快速的侧枝血流到缺血周边区域,伴持续的灌注缺陷,仅有部分到缺血区域;3级:静脉晚期可见缓慢但是完全的血流到缺血区域;4级:通过逆行灌注血流快速而完全的灌注到整个缺血区域。采用Spearman非参数相关分析FVHs评分与侧枝循环级别的相关性。结果两组患者FVHs评分(5.0±1.2 vs 3.9±0.9)及侧枝循环级别(2.9±0.7 vs 2.1±1.1)差异均存在统计学意义(P1=0.002,P2=0.008),Spearman相关分析显示血管高信号征评分与侧枝循环级别呈正相关(r=0.364,P=0.032)。结论急性缺血性脑卒中患者FLAIR血管高信号征与脑侧枝循环级别轻度相关,FLAIR血管高信号征越广泛表明患者侧枝循环越丰富,临床预后越好。Objective:To explore application value of FVHs in predicting the outcome of acute ischemic stroke by analyzing the FLAIR vascular hyperintensities(FVHs)and digital subtraction angiography(DSA)medical image in acute ischemic stroke patients with definite onset time,in order to speculate the possibility of disability of AIS patients.Materials and Methods:AIS patients of onset time within4.5hours were enrolled,and all patients did MRI examination,including FLAIR sequences and were treated with thrombolysis and thrombectomy within4.5and12hours respectively.The patients were divided into2groups according to Modified Rankin Scale:≤2(group A),>2(group B).The clinical information,DSA medical image and MRI findings between two groups were compared.The FLAIR vascular hyperintensity score was based on ASPECTS,ranging from0(no FLAIR vascular hyperintensity)to7(FLAIR vascular hyperintensities abutting all ASPECTS cortical areas).Collateral circulation was assessed according to the American society for interventional and therapeutic neuroradiology/society of interventional radiology(ASITN/SIR)collateral flow grading system:grade0:no collaterals visible at the ischemic site;grade1:slow collaterals to the periphery of the ischemic site with persistence of some of the defect;grade2:rapid collaterals to the periphery of the ischemic site with persistence of some of the defect,and to only a portion of the ischemic territory;grade3:collaterals with slow but complete angiographic blood flow of the ischemic bed by the late venous phase;and grade4:complete and rapid collateral blood flow to the vascular bed in the entire ischemic territory by retrograde perfusion.Spearman nonparametric correlation were used to analyze to the relationship between FVHs and collateral circulation levels.Results:After comparing the two groups of FVHs and collateral circulation levels,there were significant differences between group A and group B:P1=0.002,P2=0.008.Spearman correlation analysis showed that FVHs was actively correlated with collateral circu

关 键 词：卒中 液体衰减反转恢复 血管高信号征 侧枝循环 扩散加权成像 磁共振成像 

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]