SWI双侧大脑内静脉信号不对称与大动脉闭塞急性脑梗死患者恶性脑水肿及预后不良关系的研究  

The association between internal cerebral vein asymmetry on SWI and malignant brain edema/poor outcome in acute ischemic stroke patients with large vessel occlusion

作　　者：唐欢 杨峰[1] 吴承龙[1] 章燕幸[1] Tang Huan;Yang Feng;Wu Chenglong;Zhang Yanxing(Department of Neurology,Shaoxing People’s Hospital,Shaoxing 312000,China)

机构地区：[1]绍兴市人民医院神经内科,绍兴312000

出　　处：《新医学》2022年第5期324-329,共6页Journal of New Medicine

基　　金：绍兴市人民医院青年科研基金(2017B12)。

摘　　要：目的探讨大动脉闭塞(颈内动脉或大脑中动脉M1近端闭塞)的急性脑梗死患者MRI磁敏感加权成像(SWI)上双侧大脑内静脉(ICV)信号不对称与进展为恶性脑水肿以及远期预后不良是否有关。方法收集大动脉闭塞的急性脑梗死患者的临床及影像学资料;根据SWI上双侧ICV信号是否对称将其分为ICV信号对称组及ICV信号不对称组,比较2组患者发生恶性脑水肿及远期不良预后的差异。结果共纳入32例患者,美国国立卫生研究院脑卒中量表(NIHSS)评分中位数17分,ICV信号对称组19例,ICV信号不对称组13例。与ICV信号对称组相比,ICV信号不对称组进展为恶性脑水肿的比例更高(76.9%vs.5.9%,P<0.001),3个月预后良好的比例更低(23.1%vs.70.6%,P=0.025),3个月病死率更高(46.2%vs.0%,P=0.003)。二元logistic回归分析结果显示,双侧ICV信号不对称与大动脉闭塞的急性脑梗死患者发生恶性脑水肿相关(OR=43.333,95%CI:3.897~481.820,P=0.020),脑水肿进展与大动脉闭塞的急性脑梗死发病3个月预后不良相关(OR=0.330,95%CI:0.002~0.653,P=0.025)。结论大动脉闭塞的急性脑梗死患者MRI SWI序列上双侧ICV信号不对称可能与进展为恶性脑水肿有关,而脑水肿进展可能与发病3个月预后不良有关。Objective To assess whether internal cerebral vein(ICV)asymmetry on susceptibility weighted imaging(SWI)of MRI is associated with malignant brain edema(MBE)and long-term poor outcome in acute ischemic stroke(AIS)patients with large vessel occlusion(LVO);proximal occlusion of internal carotid artery or M1 segment of middle cerebral artery.Methods Clinical and image data of AIS patients with LVO were collected.According to the signal of ICV on SWI,all patients were divided into the asymmetric and non-asymmetric ICV groups.The incidence of MBE and long-term poor outcome were statistically compared between two groups.Results Thirty-two AIS patients with LVO,including 19 in the asymmetric and 13 in the non-asymmetric ICV groups,were recruited in this study.The median NIHSS score was 17.Patients with asymmetric ICV had a significantly higher incidence of MBE(76.9%vs.5.9%,P<0.001),lower proportion of 3-month good outcome(23.1%vs.70.6%,P=0.025)and higher 3-month mortality rate(46.2%vs.0%,P=0.003)compared with their counterparts with non-asymmetric ICV.Binary logistic analysis showed that asymmetric ICV was associated with the incidence of MBE in AIS patients with LVO(OR=43.333,95%CI:3.897-481.820,P=0.020).The progression of MBE was correlated with 3-month poor outcome in AIS patients with LVO(OR=0.330,95%CI:0.002-0.653,P=0.025).Conclusions For AIS patients with LVO,asymmetric ICV on SWI sequence of MRI is probably associated with the risk of MBE.Moreover,the progression of MBE may be correlated with 3-month poor outcome.

关 键 词：大动脉闭塞 脑梗死 磁敏感加权成像 恶性脑水肿 预后不良 

分 类 号：R743.33[医药卫生—神经病学与精神病学]