ASL联合SWI在亚急性缺血性脑卒中出血转化及预后评估中的应用  

Application of ASL combined with SWI in hemorrhage transformation and prognosis assessment of subacute ischemic stroke

作　　者：张爱娟 魏恒乐 张宏 徐晨辉 洪汛宁 鲁珊珊 ZHANG Ai-juan;WEI Heng-le;ZHANG Hong(Medical Imaging Department,the Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 211100,China)

机构地区：[1]南京医科大学附属江宁医院医学影像科,南京211100 [2]南京医科大学第一附属医院放射科,南京210003

出　　处：《放射学实践》2024年第7期852-858,共7页Radiologic Practice

基　　金：国家自然科学基金面上项目(82171907)。

摘　　要：目的:采用动脉自旋标记(ASL)和磁敏感加权成像(SWI)观察亚急性缺血性脑卒中梗死区高灌注与出血转化(HT)的相关性以及对90天预后的影响。方法:纳入95例亚急性缺血性卒中患者,入院后采用抗血小板聚集药物(单抗或双抗)治疗,于症状发作后3~7天内行多序列MRI检查(T_(1)WI、T_(2)WI、DWI、MRA、ASL、SWI)。收集和评估临床因素,包括人口统计学、危险因素、卒中特征等。根据ASL梗死区灌注情况分为高灌注和非高灌注,高灌注定义为梗死区脑血流量增加≥对侧的130%。根据SWI序列评估梗死区有无HT,并进一步将HT分为出血性梗死(HI)及脑实质出血(PH)。预后良好定义为90天改良Rankin量表(mRS)评分0~2分。采用独立样本t检验、Mann-Whitney U检验、χ^(2)检验或Fisher确切概率法比较HT组和无HT组各临床因素及影像特征的差异,二元Logistic回归分析明确影响HT的独立因素,进一步探讨梗死区高灌注与HT及90天临床结局的相关性。结果:HT组40例,无HT组55例,HT组患者的入院NIHSS评分更高、梗死体积更大、梗死区高灌注比例更多(P均<0.05)。梗死区高灌注是HT发生的独立危险因素(OR=8.162,P=0.001),但80%的HT表现为HI。90天预后良好组57例,预后不良组38例,预后良好组患者的入院及出院NIHSS评分更低、梗死体积更小、梗死区高灌注比例更多(P均<0.05),而HT在两组间差异无统计学意义(P>0.05)。结论:亚急性期缺血性卒中梗死区高灌注与患者90天良好预后相关,但同时高灌注是HT发生的独立危险因素,虽然大部分表现为HI,临床仍需严格管理血压,以减少PH的发生。Objective:Arterial spin labeling(ASL) and susceptibility weighted imaging(SWI) were used to observe the correlation between hyperperfusion in the infarct area and hemorrhagic transformation(HT) and the effect on 90-day prognosis in subacute ischemic stroke.Methods:Ninety-five patients with subacute ischemic stroke were included and treated with antiplatelet aggregation drugs(A drug or combined two drugs) after admission.Multiple sequence MRI(T_1WI,T_2WI,DWI,MRA,ASL,SWI) was performed within 3~7 days after symptom onset.Clinical factors were collected and evaluated,including demographics,risk factors,stroke characteristics,etc.According to ASL,the perfusion status of the infarct area were divided into hyperperfusion and non-hyperperfusion.Hyperperfusion was defined as an increase in cerebral blood flow in the infarcted area of ≥130% on the contralateral side.SWI was used to assess whether HT was present in the infarct area,and HT was further divided into hemorrhagic infarction(HI) and parenchymal hemorrhage(PH).A good prognosis was defined as Modified Rankin Scale(mRS) of 0~2 at 90 days of discharge.Independent sample T test,Mann Whitney U test,χ^(2) test or Fisher exact probability method were performed to compare the differences in clinical factors and imaging features between the HT and the non HT groups.Binary Logistic regression analysis identified the independent factors affecting HT,and further explored the correlation between hyperperfusion in infarct area,HT and 90-day clinical outcome.Results:There were 40 cases in the HT group and 55 cases in the non-HT group.The patients in HT group had higher admission NIHSS score,larger infarct volume and higher proportion of hyperperfusion in the infarct area(P<0.05).Hyperperfusion was an independent risk factor for HT(OR=8.162,P=0.001),but 80% of HT was HI.At 90 days of discharge,there were 57 patients in the good prognosis group and 38 patients in the poor prognosis group.The lower NIHSS score on admission and discharge,smaller infarct volume,and higher proport

关 键 词：动脉自旋标记 高灌注 磁敏感加权成像 亚急性期缺血性脑卒中 出血转化 

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