磁共振血管造影侧枝血管在卒中机械取栓术后预后中的应用价值  

The value of collateral vessels on magnetic resonance angiography in the prognosis of stroke patients after mechanical thrombectomy associated with clinical outcomes

作　　者：陈广浩[1] 邱建博 郑少青 殷信道[1] 彭明洋 马跃虎[1] CHEN Guanghao;QIU Jianbo;ZHENG Shaoqing;YIN Xindao;PENG Mingyang;MA Yuehu(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,南京210006

出　　处：《磁共振成像》2020年第4期270-274,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：目的探讨磁共振血管造影(magnetic resonance angiography,MRA)中侧枝血管与急性卒中机械取栓术后预后间的关系。材料与方法前瞻性纳入接受机械取栓治疗的急性卒中患者。所有患者均于治疗前及治疗后24 h内接受头颅MRI平扫和MRA检查。3个月后的预后情况根据改良Rankin量表(modified Rankin Scale,mRS)评估,mRS0~2为预后良好组,mRS3~6为预后不良组。统计学方法分析预后良好组与不良组之间侧裂及软脑膜的侧枝血管的差异。结果共55例动脉闭塞的卒中患者纳入分析(侧裂侧枝血管不丰富者52例,软脑膜侧枝血管不丰富者45例)。侧裂血管和软脑膜血管不丰富的患者,预后良好组的入院NIHSS评分(10.06±4.65 vs 14.25±4.91;P=0.006)、术前梗死体积(13.61±10.99 vs 59.80±92.74;P=0.006)均低于预后不良组。多元逻辑回归分析显示年龄、软脑膜的侧枝循环是预测预后的独立预测因子(OR=1.094,95%CI=1.025~1.168,P=0.007;OR=9.542,95%CI=1.812~50.245,P=0.008)。预后良好组的梗死增长体积(术前vs术后:14.15±10.73 vs 21.39±17.41)小于预后不良组(术前vs术后:16.88±16.64 vs 57.27±56.67),然而多元逻辑回归分析显示术后梗死体积对预测卒中预后无显著意义(OR=1.094,95%CI=1.025~1.168,P=0.154)。结论磁共振血管造影侧枝血管可用于评估卒中预后,尤其是软脑膜的侧枝循环可预测卒中预后,而术后卒中梗死体积与预后的关系仍需进一步研究。Objective:To evaluate the association between the collateral vessels on magnetic resonance angiography(MRA)and clinical outcome in acute stroke patients after mechanical thrombectomy.Materials and Methods:In this prospective study,acute stroke patients who received mechanical thrombectomy therapy were evaluated.All patients underwent head MRI plain scan and MRA examination before therapy and after therapy.Functional outcome at 3 months was assessed by using the modified Rankin Scale(mRS).mRS 0-2 is good functional outcome group and 3-6 is poor functional outcome group.Statistical methods were used to analyze the sylvian fissure and the leptomeningeal convexity differences between two groups.Results:Of 55 patients,cases with insufficient collateral circulation at the sylvian fissure(52)and leptomeningeal convexity(45)showed that the NIHSS score at arrival(10.06±4.65 vs 14.25±4.91;P=0.006)and preoperative infarct volume(13.61±10.99 vs 59.80±92.74;P=0.006)were significantly lower in mRS score of 0-2 than that in mRS score of 3-6.Multivariate testing revealed age and collateral status at the leptomeningeal convexity were independent of the clinical outcome at 3 months after stroke(OR=1.094,95%CI=1.025-1.168,P=0.007;OR=9.542,95%CI=1.812-50.245,P=0.008 respectively).The change of infarct volume in the group with mRS score of 0-2(preoperative vs postoperative:14.15±10.73 vs 21.39±17.41)was smaller than that with mRS score of 3-6(preoperative vs postoperative:16.88±16.64 vs 57.27±56.67).While multivariate logistic models showed that postoperative infarct volume was non-significant in predicting the clinical outcome after stroke(OR=1.094,95%CI=1.025-1.168;P=0.154).Conclusions:MRA can be used to evaluate the functional outcome in patients with stroke,especially the extent of collateral circulation at the leptomeningeal convexity may be useful for predicting the functional recovery.While the relationship between postoperative infarct volume and clinical outcome still requires for further study.

关 键 词：卒中 侧枝循环 机械取栓治疗 磁共振血管造影 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]