DWI梗死体积与体积增长在评估卒中血管再通术后预后中的价值  

The Predict Value of DWI Infarct Volume and Volume Growth in the Functional Outcome of Stroke After Endovascular Therapy

作　　者：邱建博 陈广浩[1] 黄红涛 高伟[1] QIU Jianbo;CHEN Guanghao;HUANG Hongtao;GAO Wei(Department of Medical Imaging,Nanjing First Hospital,Nanjing Medical University,Nanjing Jiangsu 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,江苏南京210006

出　　处：《中国医疗设备》2020年第4期55-59,共5页China Medical Devices

基　　金：国家自然科学基金(81601477)。

摘　　要：目的探讨弥散加权成像(Diffusion-Weighted Imaging,DWI)梗死体积及梗死体积增长在预测卒中血管再通术后的预后中的价值。方法前瞻性纳入在我院接受血管再通治疗的急性脑卒中患者38例。所有患者发病时间为6 h以内,均于治疗前及治疗后24 h内接受MRI检查。收集治疗前DWI梗死体积(VD1)、治疗后VDWI(VD2)、梗死体积增长(VDWI-G)、3个月功能预后(mRS评分)及一般临床资料。统计学分析预后良好组与预后不良组间各参数差异及DWI梗死体积及梗死体积增长在预测卒中预后中的价值。结果38例患者中23例(60.53%)预后良好,15例(39.47%)预后不良。与预后不良组相比,预后良好组具有较小的VD1[(13.54±15.17)mL vs.(59.32±53.27)mL;P<0.001]、较小的VD2[(28.04±21.72)mL vs.(107.69±90.37)mL;P<0.001]及较小的VDWI-G[(14.50±17.88)mL vs.(48.37±42.89)mL;P=0.010]。Spearman相关分析显示VD1(r=0.414,P=0.010)、VD2(r=0.486,P=0.002)、VDWI-G(r=0.467,P=0.003)均与3个月mRS间呈正相关。受试者工作特征曲线分析显示当VD1的最佳临界值为33.50 mL时,预测卒中功能预后的敏感性和特异性分别为60.00%和95.65%;当VD2的最佳临界值为32.80 mL时,预测卒中功能预后的敏感性和特异性分别为80.00%和78.26%;当VDWI-G的最佳临界值为13.2 mL时,预测卒中功能预后的敏感性和特异性分别为86.70%和60.87%。结论综合评估治疗前DWI梗死体积、治疗后DWI梗死体积及DWI梗死体积增长可有助于预测血管再通治疗的卒中患者的功能预后。Objective To assess the value of diffusion-weighted imaging(DWI)infarct volume and infarct volume growth in predicting the functional outcome of acute stroke patients receiving endovascular therapy.Methods A total of 38 stroke patients receiving endovascular therapy in our hospital were prospectively enrolled.The onset time of all patients was within 6 hours.All patients received MRI examination before and after treatment within 24 h.The DWI volume on admission(VD1),DWI volume on follow-up(VD2),DWI volume growth(VDWI-G),the functional outcome at 3 months(mRS)and other clinical data were collected.The difference of parameters between the good prognosis group and the bad prognosis group,the value of DWI infarct volume and infarct volume growth in predicting the prognosis of stroke were statistically analyzed.Results Of the 38 patients,23(60.53%)had good outcome and 15(39.47%)had poor outcome.Compared with the bad prognosis group,the good prognosis group had a smaller VD1[(13.54±15.17)mL vs.(59.32±53.27)mL;P<0.001],VD2[(28.04±21.72)mL vs.(107.69±90.37)mL;P<0.001]and VDWI-G[(14.50±17.88)mL vs.(48.37±42.89)mL;P=0.010].Spearman’s rank correlation analysis revealed that VD1(r=0.414,P=0.010),VD2(r=0.486,P=0.002)and VDWI-G(r=0.467,P=0.003)were all positively correlated with mRS at 3 months.Receiver operating characteristic curve analysis showed that when the optimal cut-off value of VD1 was 33.50 mL,the sensitivity and specificity for predicting functional outcome was 60.00%and 95.65%respectively;when the optimal cut-off value of VD2 was 32.80 mL,the sensitivity and specificity was 80.00%and 78.26%;when the optimal cut-off value of VDWI-G was 13.2 mL,the sensitivity and specificity was 86.70%and 60.87%respectively.Conclusion Evaluating DWI volume on admission,DWI volume on follow-up,DWI volume growth comprehensively may be useful in predicting the functional outcome of acute stroke patients after endovascular therapy.

关 键 词：弥散加权成像 梗死体积 磁共振成像 卒中 血管再通术 

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]