急性期脑梗死患者DWI与MRA诊断的一致性及影响因素分析  

Diagnosis consistency and influencing factors of DWI and MRA in patients with acute cerebral infarction

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作  者:高爽 王三刚[2] Gao Shuang;Wang Sangang(Department of General Medicine,Lai'an Jianing Hospital,Chuzhou 239200,China;Department of General Medicine,Chuzhou First People's Hospital,Chuzhou 239200,China)

机构地区:[1]来安家宁医院全科医学科,滁州239200 [2]滁州市第一人民医院全科医学科,滁州239200

出  处:《国际放射医学核医学杂志》2024年第2期82-90,共9页International Journal of Radiation Medicine and Nuclear Medicine

摘  要:目的探究磁共振DWI与磁共振血管成像(MRA)诊断急性期脑梗死(ACI)的一致性及其影响因素。方法回顾性分析2020年1月至2022年2月于来安家宁医院接受诊治的98例疑似ACI患者的临床资料并纳入训练集,其中男性58例、女性40例,年龄45~80(60.5±3.3)岁。按照相同标准选取2022年3至10月于来安家宁医院接受诊治的33例疑似ACI患者纳入验证集,其中男性18例、女性15例,年龄42~79(61.1±3.6)岁。以临床综合诊断为"金标准",分析DWI与MRA的诊断效能、影像表现和检查结果的一致性。计量资料的组间比较采用两独立样本t检验;计数资料的组间比较采用χ^(2)检验;采用多分类资料的Kappa检验分析DWI与MRA诊断ACI的一致性;采用多因素Logistic回归分析筛选DWI与MRA检查结果不一致的独立危险因素;采用Empower Stats和统计软件包"R"绘制森林图,构建风险列线图预测模型,并对模型进行评价;采用受试者工作特征(ROC)曲线和霍斯默莱梅肖拟合优度检验风险列线图预测模型的区分度和精准度;采用决策曲线评价风险列线图预测模型的精准度。结果临床综合诊断为ACI的74例患者中,DWI检出73例(98.65%),MRA检出71例(95.95%);患者健侧[≤6 h:(1.06±0.24)×10^(-4)cm^(2)/s;6~24 h:(1.13±0.26)×10^(-4)cm^(2)/s;24~72 h:(1.05±0.17)×10^(-4)cm^(2)/s]和患侧[≤6 h:(0.59±0.11)×10^(-4)cm^(2)/s;6~24 h:(0.44±0.10)×10^(-4)cm^(2)/s;24~72 h:(0.53±0.09)×10^(-4)cm^(2)/s]脑组织ADC值的差异均有统计学意义(t=10.227、12.630、7.646,均P<0.05)。患者发病后24 h内,患侧ADC值[≤6 h:(0.59±0.11)×10^(-4)cm^(2)/s;6~24 h:(0.44±0.10)×10^(-4)cm^(2)/s]、rADC[≤6 h:(0.53±0.08);6~24 h:(0.43±0.05)]均明显降低,且差异均有统计学意义(t=5.410、5.569,均P<0.05);发病24~72 h均明显升高[24~72 h ADC值:(0.53±0.09)×10^(-4)cm^(2)/s;24~72 h rADC:(0.49±0.06)],且差异均有统计学意义(t=2.274、2.835,均P<0.05)。DWI与MRA检查结果一致的患者68例(69.39%)、不一Objective To explore the consistency and influencing factors between diffusionweighted imaging(DWI)and magnetic resonance angiography(MRA)in diagnosing acute cerebral infarct(ACI).Methods Ninety-eight suspected ACI patients who received treatment at Lai'an Jianing Hospital from January 2020 to February 2022 were selected as the study subjects and included in the training set.Among them,58 were males and 40 were females,aged 45-80(60.5±3.3)years old.Suspected ACI patients(33 cases)diagnosed and treated at Lai'an Jianing Hospital from March to October 2022 were selected for retrospective analysis according to the same criteria and included in the validation set.Among them were 18 males and 15 females,aged 42-79(61.1±3.6)years old.Using clinical comprehensive diagnosis as the"gold standard",we analyzed the diagnostic efficacy,imaging manifestations,and consistency of examination results of DWI and MRA.Two independent sample ttests were used for intergroup comparison of econometric data.The intergroup comparison of counting data was conducted usingχ^(2) test.Kappa test with multiple classification data was performed to analyze the consistency between DWI and MRA in diagnosing ACI.Multiple Logistic regression analysis was conducted to screen for independent risk factors with inconsistent results between DWI and MRA examinations.Empower Stats and statistical software package"R"were used to draw a forest map,construct a risk column-chart prediction model,and evaluate the model.The discriminability and calibration of the risk-prediction model were determined using the receiver operating characteristic(ROC)curve and the Hosmer-Lemeshow goodness-of-fit test.Risk nomogram prediction model accuracy was evaluated using decision curve analysis.Results Among the 74 patients diagnosed with ACI clinically,73(98.65%)were positive for DWI and 71(95.95%)were positive for MRA.The difference in apparent diffusion coefficient(ADC)values between the healthy(≤6 h:(1.06±0.24)×10^(-4)cm^(2)/s;6-24 h:(1.13±0.26)×10^(-4)cm^(2)/s;24-

关 键 词:弥散磁共振成像 磁共振血管造影术 急性期脑梗死 一致性 影响因素 

分 类 号:R743.33[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]

 

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