神经影像预测急性椎基底动脉闭塞血管成功再通预后  

Prognostic value of neuroimaging in successful revascularization of acute vertebrobasilar artery occlusion

作　　者：白博锋 王立学 黄珊珊 李永斌 郑卓肇[1] BAI Bofeng;WANG Lixue;HUANG Shanshan;LI Yongbin;ZHENG Zhuozhao(Department of Radiology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China;Department of Radiology,Xi’an No.1 Hospital,Xi’an 710002,China)

机构地区：[1]清华大学附属北京清华长庚医院放射科清华大学临床医学院,北京102218 [2]西安市第一医院放射科,陕西西安710002

出　　处：《实用放射学杂志》2024年第6期875-879,共5页Journal of Practical Radiology

摘　　要：目的探讨神经影像评分在急性椎基底动脉闭塞(VBAO)血管成功再通患者预后中的价值。方法回顾性选取接受血管内治疗并成功再通(改良脑梗死溶栓级2b级或3级)的急性VBAO患者83例。基于基线扩散加权成像(DWI)序列,使用新型后循环评分(N-PCS)、脑干评分(BSS)和后循环Alberta卒中项目早期CT评分(pc-ASPECTS)分别评估后循环梗死情况。将90 d改良Rankin量表(mRS)评分≤2分定义为功能独立。通过受试者工作特征(ROC)曲线评估3种评分的预测价值。结果功能独立组(50例)与不良组(33例)之间N-PCS[中位数(四分位数间距):2(1~2)vs 4(2~5)]存在统计学差异(P<0.001)。多因素logistic回归分析显示,年龄[校正比值比(OR)1.08;95%置信区间(CI)1.02~1.14;P=0.006]、基线美国国立卫生研究院卒中量表(NIHSS)(校正OR 1.12;95%CI 1.03~1.20;P=0.005)和N-PCS(校正OR 2.84;95%CI 1.30~6.19;P=0.009)是预后良好的独立预测因素。结论基于DWI的N-PCS能够预测血管成功再通的急性VBAO患者预后。Objective To explore the prognostic value of neuroimaging score in patients with acute vertebrobasilar artery occlusion(VBAO)with successful revascularization.Methods A total of 83 patients with acute VBAO who underwent endovascular treatment with successful recanalization,modified thrombolysis for cerebral infarction grade 2b or 3 were retrospectively selected.Based on baseline diffusion weighted imaging(DWI)sequences,posterior circulation infarcts were assessed using the novel posterior circulation score(N-PCS),brainstem score(BSS),and posterior circulation Alberta stroke program early CT score(pc-ASPECTS).A 90 d modified Rankin scale(mRS)score≤2 points was defined as functional independence.The predictive value of the three scores was assessed by the receiver operating characteristic(ROC)curve analysis.Results The N-PCS[median(interquartile range):2(1-2)vs 4(2-5)]was statistically significant between the functional independent group(50 cases)and the poor group(33 cases)(P<0.001).Multifactorial logistic regression analysis showed that age[adjusted odds ratio(OR)1.08;95%confidence interval(CI)1.02-1.14;P=0.006],baseline National Institutes of Health Stroke Scale(NIHSS)(adjusted OR 1.12;95%CI 1.03-1.20;P=0.005),and N-PCS(adjusted OR 2.84;95%CI 1.30-6.19;P=0.009)were independent prognostic factors for a favorable prognosis.Conclusion The N-PCS based on DWI can predict the prognosis of acute VBAO patients with successful revascularization.

关 键 词：扩散加权成像 椎基底动脉闭塞 成功再通 预后 后循环 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743[医药卫生—诊断学] R818.07[医药卫生—临床医学]