基于低灌注强度比值的侧支循环对晚期时间窗急性脑卒中预后预测的研究  

A study on predicting the outcome of acute stroke in late-time windows using collateral circulation based on hypoperfusion intensity ratio

作　　者：陈乾 彭明洋 王同兴[1] 陈国中 殷信道[1] 任军[1] CHEN Qian;PENG Mingyang;WANG Tongxing;CHEN Guozhong;YIN Xindao;REN Jun(Department of Radiology,Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital),Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)医学影像科,南京210006

出　　处：《磁共振成像》2024年第7期76-80,93,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金项目(编号:82001811);中国博士后科学基金项目(编号:2022M711664)。

摘　　要：目的 以急性脑卒中患者数字减影血管造影(digital subtraction angiography, DSA)为侧支循环标准,探讨低灌注强度比值(hypoperfusion intensity ratio, HIR)在晚期时间窗急性脑卒中患者血管内治疗后预后的预测价值。材料与方法 回顾性分析2020年1月至2023年3月在本院行血管内治疗的晚期时间窗(6~24 h)急性脑卒中患者160例,侧支循环评分采用美国介入和治疗神经放射学会(American Society of Interventional and Therapeutic Neuroradiology, ASITN)分级系统评估(侧支循环良好:3~4级;侧支循环不良:0~2级)。HIR为脑血流达峰时间(time-to-maximum, T_(max))>10 s体积与T_(max)>6 s体积的比值。3个月预后采用改良Rankin量表(modified Rankin Scale, mRS)评分评估(预后良好:0~2分;预后不良:3~6分)。应用Spearman等级相关分析及受试者工作特征(receiver operating characteristic, ROC)曲线分析HIR与侧支循环间的相关性及其在晚期时间窗急性脑卒中患者预后中的预测价值。结果 与侧支循环良好组(n=90)相比,侧支循环不良组(n=70)的HIR值较高(0.45±0.07 vs.0.30±0.08;P<0.001)、出血转化率较高(44.43%vs. 20.00%;P=0.003)、早期神经功能恶化率较高(45.71%vs. 23.33%;P=0.003)及预后良好率较低(44.29%vs. 67.78%;P=0.030)。Spearman相关分析显示HIR值与ASITN分级间具有良好的负相关(预后良好组:r=-0.856;P<0.001;预后不良组:r=-0.888;P<0.001);HIR值与3个月mRS评分具有良好的正相关(r=0.773;P<0.001)。多因素logistic回归分析显示HIR [OR(95%CI):0.629(0.421~1.418);P=0.041]为晚期时间窗急性脑卒中EVT治疗后预后的独立预测因子。ROC曲线分析显示ASITN分级与HIR预测晚期时间窗急性卒中预后的预测效能差异无统计学意义(AUC:0.837 vs. 0.887;Z=1.696,P=0.090)。结论 基于HIR的侧支循环评估可准确晚期时间窗急性脑卒中血管内治疗后预后,为临床提供个性化治疗方案指导。Objective:To explore the predictive value of hypoperfusion intensity ratio(HIR)in the outcome of late-time windows acute stroke patients after endovascular thrombectomy,using digital subtraction angiography(DSA)as collateral circulation standard.Materials and Methods:A total of 160 acute stroke patients in late-time windows(6-24 hours)receiving endovascular thrombectomy therapy in our study from January 2020 to March 2023 were analyzed retrospectively.American Society of Interventional and Therapeutic Neuroradiology(ASITN)grading system was used to evaluate the collateral circulation(poor collateral circulation:0-2 grade;good collateral circulation:3-4 grade).HIR was defined as the ratio of the time-to-maximum(Tmax)>10 s over Tmax>6 s lesion volumes.Modified Rankin Scale(mRS)score was used to evaluate the outcome at 3 months(good outcome:0-2 score;poor outcome:3-6 score).Spearman rank correlation and receiver operating characteristic(ROC)curve analysis were performed to evaluate the predictive value in the outcome of acute stroke patients in the late-time windows.Results:Compared with the good collaterals group(n=90),the poor collaterals group(n=70)had higher HIR values(0.45±0.07 vs.0.30±0.08;P<0.001),higher hemorrhagic transformation rates(44.43%vs.20.00%;P=0.003),higher early neurological deterioration rates(45.71%vs.23.33%;P=0.003),and lower good outcome rates(44.29%vs.67.78%;P=0.030).Spearman correlation analysis showed good negative correlation between HIR value and ASITN grading(good outcome group:r=-0.856;P<0.001;poor outcome group:r=-0.888;P<0.001);the HIR value is positively correlated with the mRS score at 3 month(r=0.773;P<0.001).Multivariate logistic regression analysis showed that HIR[OR(95%CI):0.629(0.421-1.418);P=0.041]is independent predictors of time from stroke onset.ROC curve analysis showed that there was no significant statistical difference in the predictive efficacy of ASITN grading and HIR in predicting the outcome of acute stroke in the late-time window(AUC:0.837 vs.0.887;Z=1.696,P=0.09

关 键 词：卒中 磁共振成像 灌注成像 预后 晚期时间窗 

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]