基于血栓渗透性影像学特征对大脑中动脉急性闭塞血管内治疗预后的评估  

Evaluation of Prognosis of Acute Middle Cerebral Artery Occlusion by Endovascular Treatment Therapy Based on Imaging Features of Thrombotic Permeability

作　　者：秦江彦 祁丹 雷格格 李延静[1] QIN Jiangyan;QI Dan;LEI Gege(Department of Radiology,Cardio-Cerebrovascular Hospital,Affiliated Hospital of Yan'an University,Yan'an,Shaanxi Province 716000,P.R.China)

机构地区：[1]延安大学附属医院心脑血管病医院放射科,716000

出　　处：《临床放射学杂志》2024年第9期1466-1470,共5页Journal of Clinical Radiology

基　　金：延安市重点研发计划项目(编号:2023SLSFGG-058)。

摘　　要：目的探讨急性大脑中动脉闭塞并进行血管内治疗(EVT)的患者血栓密度增高值(TAI)与临床预后的关系。方法回顾性分析延安大学附属医院心脑血管病医院大脑中动脉闭塞并接受EVT治疗的急性缺血性脑卒中(AIS)患者58例,以第90天改良的Rankin量表(mRS)评分为因变量分为两组,预后良好组(mRS≤2)32例和预后不良组(mRS>2)26例,使用单因素及多因素逐步Logistic回归,筛选确定AIS EVT治疗后预后不良发生的独立危险因素,再通过受试者工作特征曲线(ROC)分析各危险因素对AIS患者预后评估的效能。结果多因素Logistic回归结果显示,TAI(OR:0.928,95%CI:0.864~0.996,P=0.038)、血栓密度(OR:0.816,95%CI:0.691~0.963,P=0.016)、血栓长度(OR:6.651,95%CI:1.696~26.083,P=0.007)是急性大脑中动脉闭塞并进行血管内治疗患者90天mRS预后的独立危险因素(P<0.05)。ROC曲线分析显示,TAI的AUC为0.861,最佳截断值为10.085;血栓密度AUC为0.655,最佳截断值为4.181;血栓长度的AUC为0.665,最佳截断值为17.9;TAI、血栓长度、血栓密度三个指标影像联合检测的AUC为0.911,敏感度及特异度分别为80.8%、90.6%。结论急性大脑中动脉闭塞进行血管内治疗患者90天mRS功能预后良好(mRS≤2)的患者TAI越高,血栓渗透性越高,并且TAI对急性大脑中动脉闭塞并进行血管内治疗的患者90天mRS功能预后的评估具有较好的敏感度和特异度,基于TAI所建立的影像联合指标对90天mRS功能预后的评估效能更好。Objective To investigate the relationship between thrombus attenuation increase(TAI)and clinical prognosis in patients with acute occlusion of middle cerebral artery undergoing endovascular treatment(EVT).Methods The data of 58 patients with acute ischemic stroke with middle cerebral artery occlusion and EVT treatment in Cardio-Cerebrovascular Disease Hospital Affiliated Hospital of Yan'an University were retrospectively analyzed.The 90-day modified Rankin scale(mRS)score was used as the dependent variable to divide the patients into two groups:32 cases in the good prognosis group(mRS≤2)and 26 cases in the poor prognosis group(mRS>2).Univariate and multifactor stepwise logistic regression was used.Independent risk factors for poor prognosis after EVT treatment were screened and determined,and the efficacy of each risk factor in the prognosis assessment of AIS patients was analyzed by ROC curve.Results Multivariate Logistic regression results showed that TAI,thrombus density and thrombus length were independent risk factors for 90-day mRS Prognosis in patients with acute middle cerebral artery occlusion and intravascular therapy(P<0.05).ROC curve analysis showed that the AUC of TAI was 0.861 and the optimal cutoff value was 10.85,and the thrombus density AUC was 0.655 and the optimal cutoff value was 4.181.The AUC of thrombus length was 0.665,and the optimal cut-off value was 1.78.The AUC of TAI,thrombus length and thrombus density was 0.911.Conclusion Patients with acute middle cerebral artery occlusion who underwent intravascular therapy with good 90-day mRS Function prognosis(mRS≤2)had higher TAI and higher thrombus permeability,and TAI had better sensitivity and specificity for 90-day mRS Function prognosis prediction.TAI,thrombus density and thrombus length,as a joint imaging index,have good sensitivity and specificity in predicting the prognosis of 90-day mRS Function,and are a good joint imaging biological predictor.

关 键 词：急性缺血性卒中 血管内治疗 血栓渗透性 血栓密度增高值 血栓密度 血栓长度 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]