扩散加权成像预测单侧大脑前循环缺血性脑卒中预后的价值  

The value of diffusion weighted imaging for prediction of the prognosis in unilateral anterior cerebral circulation ischemic stroke

作　　者：张远[1] 王浩[1] 朱杰[1] 孙祎 林继先 宋彬[1] ZHANG Yuan;WANG Hao;ZHU Jie;SUN Yi;LIN Jixian;SONG Bin(Department of Radiology,Minhang Hospital,Fndan University,Shanghai 201199,China;Department of Neurology,Minhang Hospital,Fndan University,Shanghai 201199,China)

机构地区：[1]复旦大学附属闵行医院放射科,上海201199 [2]复旦大学附属闵行医院神经内科,上海201199

出　　处：《实用放射学杂志》2021年第12期1941-1945,共5页Journal of Practical Radiology

摘　　要：目的探讨扩散加权成像(DWI)对超时间窗(>6 h)单侧大脑前循环缺血性脑卒中临床预后的评估价值。方法回顾性分析超时间窗单侧大脑前循环缺血性脑卒中且接受内科保守治疗患者90例,根据随访90 d后改良Rankin量表(mRS)分为预后良好组及预后不良组,2名影像科医生评估梗死区域DWI信号均匀度、边界、是否伴出血、出血比例相对值、梗死区域体积、表观扩散系数(ADC)值并记录临床基线资料,DWI影像特征与预后之间比较采用χ2检验或Fisher确切概率法,出血比例相对值、梗死区域体积、ADC值等计量资料的差异性比较采用独立样本t检验(正态分布)或秩和检验(非正态分布)。单因素分析中P<0.1的指标纳入Logistic多因素回归分析。结果单因素分析显示房颤史、吸烟史、梗死区域体积、DWI信号不均匀、梗死区域伴出血、梗死区域边界模糊、平均ADC值以及最小ADC值在预后良好组及不良组间差异有统计学意义(P<0.05)。多因素回归分析结果显示DWI信号不均匀、梗死区域体积和平均ADC值是单侧大脑前循环缺血性脑卒中预后的独立预测因素,优势比(OR)值分别为25.676、1.025、0.000029。受试者工作特征(ROC)曲线分析显示梗死区域体积、平均ADC值和最小ADC值预测单侧大脑前循环缺血性脑卒中预后的曲线下面积(AUC)分别为0.770、0.672和0.673。结论DWI可用于预测超时间窗单侧大脑前循环缺血性脑卒中预后,DWI信号不均匀、梗死区域体积、平均ADC值为独立预测因素,可对临床决策提供一定的帮助。Objective To investigate the clinical prognostic value in patients with unilateral anterior cerebral circulation ischemic stroke beyond the time window(>6 h)using diffusion weighted imaging(DWI).Methods A total of 90 patients with unilateral anterior cerebral circulation ischemic stroke beyond the time window were retrospective reviewed.The patients were divided into good prognosis group and poor prognosis group based on the modified Rankin scale(mRS)on 90 days.Lesion signal heterogeneity on DWI,margin,hemorrhage,relative value of bleeding ratio,infarct volume and apparent diffusion coefficient(ADC)value and demographic data were evaluated by two mdiologists.Chi-square test or Fisher exact probability test was used to compare DWI imaging features between the different groups.Independent sample t test(normal distribution)or rank sum test(non-normal distribution)was used to compare the differences of measurement data including relative value of bleeding ratio,infarct volume and ADC value.The indexes with P<C0.1 in univariate analysis were included in Logistic multivariate regression analysis.Results Univariate analysis showed that there were significant differences in atrial fibrillation history,smoking history,infarct volume,DWI signal heterogeneous,infarct with hemorrhage,blurred infarct margin,average ADC value and minimum ADC value between good prognosis group and poor prognosis group(P<C0.05).The results of multivariate regression analysis showed that DWI signal heterogeneous,infarct volume and average ADC value were independent predictors of unilateral anterior cerebral circulation ischemic stroke odds ratio(OR)=25.676,1.025,0.000029,respectively.Receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of infarct volume,average ADC value and minimum ADC value predicting the prognosis of unilateral anterior cerebral circulation ischemic stroke were 0.770,0.672 and 0.673 respectively.Conclusion DWI can be used to predict the prognosis of unilateral anterior cerebral circulat

关 键 词：磁共振成像 扩散加权成像 缺血性脑卒中 预测 预后 

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]