基于临床/多模态MRI的大脑中动脉粥样硬化性狭窄缺血性卒中风险评估系统  

An evaluation system for the ischemic stroke risk in atherosclerotic middle cerebral artery stenosis patients using clinical multi-modality magnetic resonance imaging

作　　者：唐小平[1] 肖新兰[1] 龚良庚[1] 漆学良[2] 尹建华[1] 盛天乐 汪雪枫 张冉[1] TANG Xiaoping;XIAO Xinlan;GONG Lianggeng;QI Xueliang;YIN Jianhua;SHENG Tianle;WANG Xuefeng;ZHANG Ran(Department of Radiology,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院影像中心,南昌330006 [2]南昌大学第二附属医院神经内科,南昌330006

出　　处：《功能与分子医学影像学（电子版）》2019年第2期1631-1639,共9页Functional and Molecular Medical Imaging(Electronic Edition)

基　　金：江西省卫生健康委员会科技计划项目(20185246);江西省科技厅应用研究培育计划项目(20181BBG78065)

摘　　要：目的建立一种基于临床/多模态磁共振成像(MRI)的大脑中动脉(MCA)粥样硬化性狭窄缺血性卒中风险评估系统,以提高预测急性缺血性脑卒中风险的准确性。方法 197例MCA粥样硬化性狭窄患者完成多模态MRI检查,包括颅脑MRI+MRA、弥散加权成像(DWI)、高分辨率磁共振成像(HR-MRI)及三维准连续式动脉自旋标记(3D-pCASL)。根据DWI表现分为脑梗死组和无脑梗死组。评价两组Essen卒中风险评分(ESRS)、超敏C-反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)、血管狭窄程度、斑块易损性及脑血流量(CBF)等临床/影像学信息对急性缺血性卒中的影响。采用多因素分析筛查出单因素分析中具有统计学意义的参数作为卒中风险评估系统的组成部分,应用受试者工作特征曲线(ROC)分析获得各参数的阈值评分,整合后获得临床/多模态MRI评分,ROC曲线下面积(AUC)用于急性缺血性卒中风险效能评估。结果脑梗死组与无脑梗死组在ESRS、hs-CRP、Hcy、狭窄程度、易损斑块及CBF值之间差异均具有统计学意义。多因素分析显示ESRS、hs-CRP和(或)Hcy、狭窄程度、易损斑块及CBF值为缺血性卒中风险因素,构成临床/多模态MRI评分系统的五个因素。ROC曲线分析获得以上五个参数评估缺血性卒中风险的阈值分别为ESRS≥4分、狭窄率> 60﹪、易损斑块阳性、CBF值≤30 ml/(min·100g)及hs-CRP> 9 mg/l和(或)Hcy> 15 umol/l。临床/多模态MRI评分系统的AUC最大(AUC=0.937,P <0.001),敏感度为89.1﹪,特异度为83.8﹪,其预测急性缺血性卒中风险的效能最高,其次是Hcy(AUC=0.880,P <0.001)、hs-CRP(AUC=0.850,P <0.001)、ESRS(AUC=0.793,P <0.001)、CBF值(AUC=0.720,P <0.001)和狭窄程度(AUC=0.627,P=0.002)。结论临床/多模态MRI评分系统比单纯ESRS量表和各影像学参数判断急性缺血性脑卒中风险的效能更高。结合血管影像学改变、临床特征及血清生化检查极大地提高了评估急性缺血性脑卒中Objective To establishan evaluation system for the ischemic stroke risk in atherosclerotic middle cerebral artery(MCA)stenosis patients and improve the accuracy of the predictions for acute ischemic stroke risk using clinical multi-modality magnetic resonance imaging(MRI). Methods Multi-modality MRI technique was used to examine 197 patients with atherosclerotic MCA stenosis. Multi-modality MRI technique including conventional MRI, magnetic resonance angiography(MRA), diffusion weighted imagine(DWI), high resolution magnetic resonance imaging(HR-MRI) and 3D-pulsed continuous arterial spin labeling(3 D-pCASL). All patients were divided into two groups: cerebral infarction and no cerebral infarction groups according to DWI findings. Baseline clinical and radiologic variables include Essen Stroke Risk Score(ESRS), high-sensitivity C-reactiveprotein(hs-CRP), homocysteine(Hcy), vascular stenosis, and vulnerable plaqueandcerebral blood flow(CBF). A univariate analysis was conducted to evaluate the correlation between these factors and schemic stroke risk. Logistic regression was then performed to select the most important variables independently predicting prognosis. Receiver operator characteristic curve(ROC)was then used to obtain cut-off points for each independent variable. A risk score(clinical and multi-modality MRI score)was then calculated based on these variables. The area under the ROC was calculated for the evaluation effectiveness. Results In the univariate analysis, variables associated with ischemic stroke were: ESRS, hs-CRP, Hcy, the degree of MCA stenosis, vulnerable plaque and CBF. Five variables independently correlated with ischemic stroke were identified by logistic regression: ESRS, hs-CRP and(or)Hcy, the degree of MCA stenosis, vulnerable plaque and CBF. We then developed the clinical and multi-modality MRI score: ESRS ≥ 4 score, the degree of MCA stenosis > 60 ﹪, vulnerable plaque was postive, CBF ≤ 30 ml/(min·100 g)and hs-CRP > 9 mg/l and(or)Hcy > 15 umol/l. The factor that most accuratel

关 键 词：缺血性脑卒中 风险 大脑中动脉 粥样硬化 磁共振成像 动脉自旋标记 

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