DWI联合MRI斑块参数对老年急性脑梗死rt-PA溶栓治疗预后的预测价值  

Prognostic value of diffusion-weighted imaging quantitative parameters combined with MRI plaque parameters for rt-PA thrombolytic therapy in elderly patients with acute cerebral infarction

作　　者：王瑞杰 李博[2] 程星瑶 李磊 WANG Rui-jie;LI Bo;CHENG Xing-yao;LI Lei(Department of Radiology,General Hospital of Yima Coal Industry Group Co.,LTD.,Yima 472300,Henan,CHINA;Department of Radiology,West China Hospital,Sichuan University,Chengdu 610041,Sichuan,CHINA;Department of Radiology,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,Henan,CHINA)

机构地区：[1]义马煤业集团股份有限公司总医院放射科,河南义马472300 [2]四川大学华西医院放射科,四川成都610041 [3]河南科技大学第一附属医院放射科,河南洛阳471000

出　　处：《海南医学》2024年第19期2828-2833,共6页Hainan Medical Journal

基　　金：2020年河南省医学科技攻关计划联合共建项目(编号:LHGJ20201565)。

摘　　要：目的探讨磁共振扩散加权成像(DWI)联合磁共振成像(MRI)斑块参数对老年急性脑梗死(ACI)重组组织型纤溶酶原激活剂(rt-PA)溶栓治疗预后的预测价值。方法前瞻性选取2021年1月至2024年1月义马煤业集团股份有限公司总医院收治179例行rt-PA溶栓治疗的老年ACI患者作为研究对象,根据治疗90 d后改良Rankin量表(mRS)评分分为预后良好组和预后不良组。比较两组患者的一般资料、DWI定量参数[表观扩散系数(ADC)]及MRI斑块参数(纤维帽厚度、脂核面积、斑块面积、脂核/斑块面积),采用Logistic回归分析老年ACI患者rt-PA溶栓预后的影响因素,采用受试者工作特征(ROC)曲线分析DWI定量参数联合MRI斑块参数对rt-PA溶栓预后不良的预测价值。结果随访90 d,179例患者共1例脱落,178例患者中预后良好143例,预后不良35例;预后良好组和预后不良组患者的吸烟史[21.68%vs 40.00%]、饮酒史[24.48%vs 45.71%]和治疗前美国国立卫生院卒中量表(NIHSS)评分[(12.49±1.05)分vs(13.27±1.14)分]比较差异均有统计学意义(P<0.05);预后不良组患者的ADC、纤维帽厚度值分别为(0.71±0.22)10^(-3)mm^(2)/s、(0.64±0.19)mm,明显小于预后良好组的(0.96±0.25)10^(-3)mm^(2)/s、(1.02±0.33)mm,脂核面积、斑块面积、脂核/斑块面积值分别为(4.61±1.29)mm^(2)、(9.54±1.31)mm^(2)、(48.32±15.43)%,明显大于预后良好组的(2.49±0.78)mm^(2)、(8.15±1.02)mm^(2)、(30.55±9.76)%,差异均有统计学意义(P<0.05);Logistic回归分析结果显示,矫正其他因素后,ADC、纤维帽厚度、脂核面积、斑块面积、脂核/斑块面积仍是老年ACI患者预后不良的独立影响因素(P<0.05);ROC曲线分析结果显示,ADC、纤维帽厚度、脂核面积、斑块面积、脂核/斑块面积联合预测老年ACI患者rt-PA溶栓后预后不良的曲线下面积(AUC)为0.912,约登指数为0.767,优于各指标单独检测效能。结论DWI、MRI斑块参数与老年ACI rt-PA溶栓治疗预后�Objective To explore the predictive value of diffusion-weighted imaging(DWI)combined with magnetic resonance imaging(MRI)plaque parameters for the prognosis of recombinant tissue-type plasminogen activator(rt-PA)thrombolytic therapy in elderly patients with acute cerebral infarction(ACI).Methods A prospective study was conducted to select 179 elderly patients with ACI who underwent rt-PA thrombolysis treatment at the General Hospital of Yima Coal Industry Group Co.,Ltd.from January 2021 to January 2024.The patients were divided into a good prognosis group and a poor prognosis group based on the modified Rankin scale(mRS)score after 90 days of treatment.The general information,DWI quantitative parameters(apparent diffusion coefficient,ADC),and MRI plaque parameters(fibrous cap thickness,lipid core area,plaque area,lipid core/plaque area)of the two groups of patients were compared.Logistic regression analysis was used to analyze the factors affecting the prognosis of rt-PA thrombolysis in elderly ACI patients,and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of DWI quantitative parameters combined with MRI plaque parameters for poor prognosis of rt-PA thrombolysis.Results During the 90-day follow-up,179 patients were followed up and 1 patient dropped out.Among the 178 patients,143 had a good prognosis and 35 had a poor prognosis.There were significant differences in the smoking history,drinking history,and National Institutes of Health Stroke Scale(NIHSS)score before treatment between the good prognosis group and the poor prognosis group(P<0.05):21.68%vs 40.00%,24.48%vs 45.71%,and(12.49±1.05)points vs(13.27±1.14)points.The ADC and fibrous cap thickness values in the poor prognosis group were(0.71±0.22)10^(-3) mm^(2)/s and(0.64±0.19)mm,respectively,which were significantly lower than(0.96±0.25)10^(-3) mm^(2)/s and(1.02±0.33)mm in the good prognosis group;the values of lipid core area,plaque area,and lipid core/plaque area were(4.61±1.29)mm^(2),(9.54±1.31)mm^(2),and(

关 键 词：急性脑梗死 磁共振扩散加权成像 斑块参数 溶栓 预后 预测 

分 类 号：R743.33[医药卫生—神经病学与精神病学]