FLAIR血管高信号在评估未再灌注治疗的卒中预后中的价值  

The value of FLAIR vascular hyperintensity in evaluating the outcome of stroke after non-reperfusion therapy

作　　者：黄红涛 靳明旭[1] 彭明洋 殷信道[1] 王薇[1] HUANG Hongtao;JIN Mingxu;PENG Mingyang;YIN Xindao;WANG Wei(Department of Radiology,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

出　　处：《磁共振成像》2020年第1期6-10,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：目的探讨液体衰减反转恢复序列血管高信号(fluid-attenuated inversion recovery vascular hyperintensity,FVH)在未接受再灌注治疗的轻度症状大脑中动脉闭塞的卒中患者预后中的价值。材料与方法前瞻性纳入2017年1月至2019年3月在本院就诊的具有轻度症状的急性卒中患者[入院美国国立卫生研究院卒中量表(National Institute of Health stroke scale;NIHSS)评分≤5分]。所有患者均于治疗前接受磁共振成像检查,且经磁共振血管造影(MR angiography,MRA)检查为大脑中动脉闭塞。根据FVH显著存在与否,将FVH分为两组:FVH(-)和FVH(+)组。收集所有患者的弥散张量成像(diffusionweighted imaging,DWI)梗死体积、3个月功能功能预后(mRS评分)及一般临床资料等。统计学分析FVH在未接受再灌注治疗的轻度症状大脑中动脉闭塞的卒中患者预后中的价值。结果在未接受再灌注治疗的患者中(48例),FVH(-)组FVH-DWI不匹配率(23.81%)、不良功能预后比例(14.29%)低于FVH(+)组(66.67%;51.85%),差异有统计学意义(t=8.694,P=0.004;t=7.288,P=0.014)。与预后良好组相比,不良功能预后组具有较低的FVH-DWI不匹配率(23.81%与61.29%)、较大的DWI梗死体积(6.60±1.11与4.43±2.20)及较高的FVH(+)率(82.35%与41.94%),差异有统计学意义(t=6.273,P=0.017;t=4.447,P=0.000;t=7.288,P=0.014)。逻辑回归分析结果显示DWI梗死体积[OR(95%CI)]:0.327[(0.154~0.698),P=0.004]、FVH[OR(95%CI)]:6.462[(1.536~27.179),P=0.011]及FVH-DWI不匹配[OR(95%CI)]:0.099[(0.025~0.389),P=0.001]为预测未接受再灌注治疗患者卒中预后的独立预测因子。结论对于未接受再灌注治疗的轻度症状大脑中动脉闭塞的卒中患者,FVH显著比FVH不显著的患者更可能出现不良的功能预后。Objective:To investigate the prognostic value of fluid-attenuated inversion recovery vascular hyperintensity(FVH)in outcome of stroke patients with mild symptoms and middle cerebral artery occlusion after non-reperfusion therapy.Materials and Methods:The stroke patients with mild symptoms[National Institute of Health stroke scale(NIHSS)≤5 score]who were admitted to our hospital from January 2017 to March 2019 were rolled prospectively.All patients underwent magnetic resonance imaging(MRI)before therapy and were diagnosed as middle cerebral artery occlusion in MR angiography(MRA).According to the presence or absence of FVH,FVH was divided into two groups:FVH(-)and FVH(+).Diffusion weighted imaging(DWI),infarct volume,3-month functional outcome(mRS score)and clinical data were collected.Statistical analysis was performed to evaluate the prognostic value of FVH in outcome of stroke patients with mild symptoms and middle cerebral artery occlusion after nonreperfusion therapy.Results:In patients with non-reperfusion therapy(n=48),the FVH-DWI mismatch rate(23.81%),the poor outcome(14.29%)in FVH(-)group were lower than those in FVH(+)group(66.67%;51.85%),and the difference was significant(t=8694,P=0.004;t=7.288,P=0.014).Compared with the good outcome group,the poor outcome group had lower FVH-DWI mismatch rate(23.81%vs 61.29%),larger DWI infarct volume(6.60±1.11 vs 4.43±2.20)and higher FVH(+)rate(82.35%vs 41.94%),there were significant difference(t=6.273,P=0.017;t=4.447,P=0.000;t=7.288,P=0.014).Logistic regression analysis showed that DWI infarct volume[OR(95%CI)]:0.327[(0.154-0.698),P=0.004],FVH[OR(95%CI)]:6.462[(1.536-27.179),P=0.011]and FVH-DWI mismatch[OR(95%CI)]:0.099[(0.025-0.389),P=0.001]were independently factors in outcome of stroke patients with non-reperfusion therapy.Conclusions:For stroke patients with mild symptoms and middle cerebral artery occlusion with non-reperfusion therapy,those with prominent FVH are more likely to have poor outcome than those without prominent FVH.

关 键 词：卒中 磁共振成像 预后 液体衰减反转恢复序列血管高信号 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.33[医药卫生—诊断学]