磁敏感加权成像上深髓静脉征对急性前循环脑梗死预后的预测价值研究  

Prognostic value of deep medullary vein signs on magnetic sensitive weighted imaging in acute anterior circulation cerebral infarction

作　　者：洪云 朱幼玲 黄治飞 翟登月 张振华 王盛磊 Hong Yun;Zhu Youling;Huang Zhifei;Zhai Dengyue;Zhang Zhenghua;Wang Shenglei(Department of Neurology, Third Affiliated Hospital of Anhui Medical University (First People's Hospital of Hefei), Hefei 230061, China;Department of Radiology, Third Affiliated Hospital of Anhui Medical University (First People's Hospital of Hefei), Hefei 230061, China)

机构地区：[1]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,230061 [2]安徽医科大学第三附属医院(合肥市第一人民医院)放射科,230061

出　　处：《中华神经医学杂志》2019年第5期464-469,共6页Chinese Journal of Neuromedicine

基　　金：合肥市科技局"借转补"科研项目(合科(2017)112号);合肥市医学第五周期重点学科资助项目(合卫科教(2016)256号);合肥市卫生计生委2016年应用医学项目(hwk2016zc002).

摘　　要：目的探讨急性前循环脑梗死患者磁敏感加权成像(SWI)上深髓静脉征(DMVs)的分布、分级与临床预后的相关性。方法对自2016年8月至2017年12月就诊于安徽医科大学第三附属医院神经内科的50例急性前循环脑梗死患者行SWI扫描以评估DMVs情况,采用单因素分析及多因素Logistic回归分析评估DMVs的分布与患者临床预后的相关性,同时进一步对病灶同侧的DMVs进行分级,并采用箱线图描述其与患者改良Rankin量表(mRS)评分的关系。结果50例患者中36例(72%)存在DMVs(病灶同侧19例,病灶对侧17例)。多因素Logistic回归分析显示病灶同侧DMVs为预后不良的独立危险因素(OR=3.380,95%CI:1.006~11.393,P=0.049);而病灶对侧DMVs虽不能独立预测预后,但其多出现于预后良好组中(44.8%)。病灶同侧DMVs中1级7例、2级9例、3级3例,箱线图分析示DMVs 3级有更高的mRS评分(平均为4分)。结论急性前循环脑梗死患者SWI上出现病灶同侧DMVs可独立预测预后不良,而出现病灶对侧DMVs多提示预后良好。Objective To investigate the correlations of distribution and grading of deep medullary veins (DMVs) with clinical prognoses of patients with acute anterior circulation infarction by using susceptibility-weighted imaging (SWI). Methods Fifty patients with acute anterior circulation infarction, admitted to our hospital from August 2016 to December 2017, were enrolled in our study. SWI was performed to evaluate the DMVs. Univariate and multivariate Logistic regression models were used to determine the correlation between distribution of DMVs and clinical prognoses of patients. DMVs on the ipsilateral side of the lesions were further graded and analyzed;boxplot was used to describe its relation with modified Rankin scale (mRS) scores of the patients. Results DMVs were observed in 36 patients (72%), with 19 ipsilateral DMVs and 17 contralateral DMVs. The ipsilateral DMVs were independently associated with poor outcome (odds ratio=3.380, 95%CI: 1.006-11.393, P=0.049). The contralateral DMVs were not independent predictors for outcomes, but appeared commonly in patients with good outcome (44.8%). In patients with ipsilateral DMVs, grading 1, grading 2, and grading 3 were noted in 7, two and three patients, respectively;boxplot analysis showed that DMVs patients of grading 3 had higher mRS scores, with an average of 4. Conclusion The ipsilateral DMVs on SWI are independent predictive biomarkers for poor clinical outcome after stroke, and contralateral DMVs often indicate good prognosis.

关 键 词：磁敏感加权成像 深髓静脉征 急性脑梗死 前循环 临床预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]