HR-VWI联合DWI-ASPECTS预测急性缺血性脑卒中短期预后的价值  

Predictive value of HR-VWI combined with DWI-ASPECTS for short-term prognosis of acute ischemic stroke

作　　者：王市伟 赵霞[1] 朱继兰[1] 顾华勇 WANG Shiwei;ZHAO Xia;ZHU Jilan;GU Huayong(Department of Radiology,The Affiliated Qingdao Central Hospital of Qingdao University,Shandong 266042,China)

机构地区：[1]青岛大学附属青岛市中心医院放射科,山东青岛266042 [2]青岛大学附属青岛市中心医院分子影像科,山东青岛266042

出　　处：《影像诊断与介入放射学》2023年第3期194-200,共7页Diagnostic Imaging & Interventional Radiology

摘　　要：目的探讨高分辨磁共振血管壁成像(HR-VWI)联合基于扩散加权成像的Alberta卒中项目早期CT评分(DWI-ASPECTS)在急性缺血性脑卒中(AIS)短期预后评估中的预测价值。方法选取2020年9月~2022年9月我院收治的AIS患者483例为研究对象,根据患者出院3个月随访改良Rankin量表(mRS)评分将其分为预后良好组(mRS评分0~2)394例与预后不良组(mRS评分3~5)89例。收集两组患者的临床资料,比较两组入院时HR-VWI参数[管腔面积(LA)、管壁面积(WA)、管腔狭窄程度、斑块负荷、斑块强化率、重构指数]和DWI-ASPECTS的差异,多元线性回归分析AIS患者短期预后不良的危险因素,采用受试者工作特征曲线(ROC)分析HR-VWI联合DWI-ASPECTS对AIS患者短期预后的预测价值。结果预后良好组发病至入院时间(3.36±1.15)h短于预后不良组(5.21±2.03)h,美国国立卫生研究院卒中量表(NIHSS)评分(10.53±1.18)低于预后不良组(11.68±1.23),差异有统计学意义(P<0.001)。预后良好组LA(45.58±5.04)mm、DWI-ASPECTS(7.56±1.01)大于预后不良组(43.37±4.89、6.02±1.05),WA(27.05±2.83)mm、管腔狭窄程度(50.26±5.58)、斑块负荷(44.56±5.16)、斑块强化率(54.48±6.23)、重构指数(0.94±0.12)小于预后不良组(30.17±3.05、52.37±6.01、47.10±4.74、57.06±5.98、1.02±0.15),差异有统计学意义(P<0.05)。多元线性回归分析结果显示,发病至入院时间、NIHSS评分、管腔狭窄程度、斑块负荷、重构指数、DWI-ASPECTS均是AIS患者短期预后的独立影响因素(P<0.05)。ROC曲线分析示管腔狭窄程度、斑块负荷、重构指数、DWI-ASPECTS预测AIS患者短期预后不良的曲线下面积(AUC)分别为0.742(95%CI:0.653~0.831)、0.770(95%CI:0.683~0.856)、0.753(95%CI:0.667~0.839)、0.761(95%CI:0.673~0.849),联合检测的AUC为0.859(95%CI:0.795~0.924)。结论HR-VWI联合DWI-ASPECTS在AIS短期预后评估中有良好预测价值。Objective To investigate the predictive value of high-resolution magnetic resonance vessel wall imaging(HR-VWI)combined with diffusion-weighted imaging Alberta Stroke Program Early CT Score(DWI-ASPECTS)based on DWI in short-term prognosis evaluation of acute ischemic stroke(AIS).Methods From September 2020 to September 2022,483 patients with AIS admitted to our hospital were divided into 394 cases into the good prognosis group with modified Rankin Scale(mRS)score of 0-2(394)and poor prognosis group with mRS score of 3-5(89)at 3-month follow-up.The clinical data,differences in HR-VWI parameters including lumen area(LA),wall area(WA),degree of lumen stenosis,plaque load,plaque intensification rate,and remodeling index,and DWI-ASPECTS at the time of admission were compared between the two groups.Multiple linear regression was used to analyze the risk factors for poor short-term prognosis.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of HR-VWI combined with DWI-ASPECTS on the short-term prognosis of patients with AIS.Results The time from onset of stroke to hospital admission was significantly shorter(P<0.001)in the good-prognosis group[(3.36±1.15)h]than in the poor-prognosis group[(5.21±2.03)h].The National Institutes of Health Stroke Scale(NIHSS)score in the good-prognosis group(10.53±1.18)was also significantly lower(P<0.001)than that of the poor-prognosis group(11.68±1.23).The LA[(45.58±5.04)mm]and DWI-ASPECTS(7.56±1.01)in the good prognosis group were significantly greater(P<0.05)than those in the poor prognosis group(43.37±4.89,6.02±1.05)whereas the WA[(27.05±2.83)mm],degree of lumen stenosis(50.26±5.58),plaque load(44.56±5.16),plaque enhancement rate(54.48±6.23),and remodeling index(0.94±0.12)in the good-prognosis group were significantly smaller(P<0.05)than those in the poor prognosis group(30.17±3.05,52.37±6.01,47.10±4.74,57.06±5.98,1.02±0.15).Multiple linear regression analysis showed that time from onset to admission,NIHSS score,degree of lumen steno

关 键 词：急性缺血性脑卒中 高分辨磁共振血管壁成像 基于扩散加权成像 Alberta卒中项目早期CT评分 预后预测 

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