多模态MRI成像对急性缺血性脑卒中早期神经功能恶化及临床预后的预测价值  

The application value of multimodal MRI imaging in early neurological deterioration and clinical prognosis prediction of acute ischemic stroke

作　　者：张沐源 崔瑜 胡娜 许宏伟[1] 高腾蛟 郑义[1] Zhang Muyuan;Cui Yu;Hu Na;Xu Hongwei;Gao Tengjiao;Zheng Yi(Department of Radiological Imaging,Chengde Central Hospital,Chengde 067000,China)

机构地区：[1]承德市中心医院放射医学影像科,承德067000

出　　处：《中国医师杂志》2024年第2期218-222,共5页Journal of Chinese Physician

基　　金：承德市科学技术研究与发展计划项目(201903A010)。

摘　　要：目的探讨多模态MRI成像在急性缺血性脑卒中(AIS)早期神经功能恶化(END)及临床预后预测中的应用价值。方法选取2019年10月至2022年10月承德市中心医院收治的200例AIS患者作为研究对象。根据入组7 d内是否发生END分组,发生组40例,未发生组160例,分析AIS患者发生END的影响因素及多模态MRI成像参数对END的预测价值;根据改良Rankin(mRS)评分分为预后良好、预后不良组,分析多模态MRI成像参数对AIS患者预后不良风险的影响。结果END发生组与未发生组在溶栓后多模态MRI成像相关参数表观扩散系数(ADC)、脑血流量(CBF)及其溶栓前后差值、入院时美国国立卫生研究院卒中量表(NIHSS)评分、年龄、发病至入院时间方面比较差异均有统计学意义(均P<0.05)。ADC、CBF溶栓前后差值、发病至入院时间、入院时NIHSS评分、年龄均为AIS患者发生END的独立影响因素(均P<0.05)。ADC、CBF溶栓前后差值联合预测AIS患者发生END的曲线下面积(AUC)为0.924,高于单一指标预测(P<0.05)。发生END患者预后不良发生率明显高于未发生患者,差异有统计学意义(P<0.05)。ADC溶栓前后差值<45.83×10^(-6) mm^(2)/s的AIS患者预后不良发生风险是≥45.83×10^(-6) mm^(2)/s患者的3.136倍;CBF溶栓前后差值<10.52 ml/(min·100 g)的AIS患者预后不良发生风险是≥10.52 ml/(min·100 g)患者的2.640倍。结论多模态MRI成像检查可用于AIS患者END评估,可为临床评估预后提供参考。Objective To explore the application value of multimodal MRI imaging in early neurological deterioration(END)and clinical prognosis prediction of acute ischemic stroke(AIS).Methods A total of 200 AIS patients admitted to the Chengde Central Hospital from October 2019 to October 2022 were selected as the study subjects.Based on whether END occurred within 7 days of enrollment,there were 40 cases in the occurrence group and 160 cases in the non occurrence group.The influencing factors of END occurrence in AIS patients and the predictive value of multimodal magnetic resonance imaging(MRI)parameters on END were analyzed;According to the modified Rankin(mRS)score,patients were divided into good prognosis and poor prognosis groups,and the impact of multimodal MRI imaging parameters on the risk of poor prognosis in AIS patients was analyzed.Results There were statistically significant differences in the apparent diffusion coefficient(ADC),cerebral blood flow(CBF),and their differences before and after thrombolysis in multimodal MRI imaging parameters between the END group and the non END group,as well as in the National Institutes of Health Stroke Scale(NIHSS)score at admission,age,and time from onset to admission(all P<0.05).The difference between ADC and CBF before and after thrombolysis,time from onset to admission,NIHSS score at admission,and age were all independent influencing factors for the occurrence of END in AIS patients(all P<0.05).The area under the curve(AUC)of the combined prediction of the difference between ADC and CBF before and after thrombolysis for the occurrence of END in AIS patients was 0.924,which was higher than that predicted by a single indicator(P<0.05).The incidence of poor prognosis in patients with END was significantly higher than that in patients without END(P<0.05).The risk of poor prognosis in AIS patients with a difference of less than<45.83×10^(-9) mm^(2)/s before and after ADC thrombolysis was 3.136 times higher than that in patients with≥45.83×10^(-6) mm^(2)/s.The risk of poor

关 键 词：磁共振成像 缺血性卒中 神经功能恶化 预后 脑血流量 

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]