区域性动脉自旋标记联合TOF-MRA对缺血性卒中患者侧支循环的评估价值  

Value of territorial arterial spin labeling combined with TOF-MRA on collateral circulation in acute ischemic stroke patients

作　　者：幸章力 曾芳[1] 孙斌[1] 佘李岚 郑恩双 段青[1] 薛蕴菁[1] XING Zhang-li;ZENG Fang;SUN Bin;SHE Li-lan;ZHENG En-shuang;DUAN Qing;XUE Yun-jing(Department of Radiology,Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院影像科,福建福州350001

出　　处：《中国临床医学影像杂志》2022年第9期612-617,共6页Journal of China Clinic Medical Imaging

基　　金：2020年卫生健康青年科研课题立项(项目编号:2020QNB018);福建省科技创新联合资金项目(项目编号:2018Y9025)。

摘　　要：目的:以多时相CTA为标准,联合区域性动脉自旋标记(t-ASL)与TOF-MRA评估急性缺血性卒中患者侧支循环的开放情况,并探讨侧支循环与临床预后的关系。方法:前瞻性收集急性缺血性卒中患者52例。以多时相CTA为标准,联合t-ASL与TOF-MRA评估卒中患者的侧支循环,并计算Cohen’s Kappa系数值。记录卒中患者出院1月后的改良Rankin量表(mRS)评分,使用Logistic回归分析经t-ASL联合TOF-MRA评估的侧支循环开放情况与临床预后之间的关系。结果:在26例同时行MR和CTA扫描的患者中,联合t-ASL与TOF-MRA对侧支开放的评估与多时相CTA的一致性中等(Cohen’s Kappa:0.667,95%CI:0.261~1.073,P<0.05)。在伴有大动脉急性狭窄或闭塞的19例卒中患者中,经校正干扰因素后,Logistic回归显示侧支循环不是患者出院1月预后良好的独立预测因素(OR:0.018;95%CI:0~1.295;P=0.063)。结论:t-ASL联合TOF-MRA能较好地对卒中患者侧支循环进行评估,经t-ASL联合TOF-MRA评估的二级侧支循环不能独立预测患者的1月预后。Objective: To evaluate the opening of collateral circulation in acute ischemic stroke(AIS) patients by territorial-ASL(t-ASL) combined with TOF-MRA using multiphase CTA(mCTA) as the standard, and explore the relationship between collateral circulation and clinical prognosis. Methods: Fifty-two AIS patients were collected prospectively. Using mCTA as the standard, the collateral circulation of stroke patients was evaluated by t-ASL combined with TOF-MRA. Cohen’s Kappa cofficient was calculated. Modified Rankin Scale(mRS) scores of patients 1 month after discharge were recorded. A logistic regression model was used to analyze the relationship between the establishment of collaterals and clinical outcome.Results: Among the 26 patients who underwent MR and CTA scans at the same time, combined t-ASL and TOF-MRA for assessment of collaterals showed moderate agreement with mCTA(Cohen’s Kappa=0.667, 95%CI: 0.261~1.073, P<0.05). In 19stroke patients with acute stenosis or occlusion of the great arteries, after adjusting for interfering factors, logistic regression showed that collateral circulation was not an independent predictor of good prognosis for AIS patients at 1 month after discharge(OR: 0.018;95% CI: 0 ~1.295, P =0.063). Conclusion: T-ASL combined with TOF-MRA can better evaluate the collaterals in AIS patients. The presence of secondary collaterals assessed by t-ASL combined with TOF-MRA can’t independently predict the prognosis at 1 month after discharge.

关 键 词：卒中 磁共振成像 体层摄影术 螺旋计算机 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R814.42[医药卫生—临床医学] R445.2