急性缺血性脑卒中患者动态MRI血管图侧支循环分级变化及对预后评估价值  

Changes of collateral circulation grading of dynamic MRI angiogram in patients with acute ischemic stroke and its evaluated value on prognosis

作　　者：席光明[1] 屈斐 陈召东 XI Guangming;QU Fei;CHEN Zhaodong(Shangluo Central Hospital,Shangluo 726000,China)

机构地区：[1]商洛市中心医院,陕西商洛726000

出　　处：《中国实用神经疾病杂志》2024年第12期1557-1561,共5页Chinese Journal of Practical Nervous Diseases

基　　金：陕西省重点研发项目(编号:2019JM7512)。

摘　　要：目的探究急性缺血性脑卒中(AIS)患者动态磁共振成像(MRI)血管图侧支循环分级变化及对预后评估价值。方法回顾性分析2018-01—2023-12于商洛市中心医院同时进行动态MRI与数字减影血管造影(DSA)检查的159例疑似AIS患者临床资料,将DSA检查作为诊断金标准,分析动态MRI血管图对AIS患者的诊断效能;以DSA临床分期结果为侧支循环分级评估依据,评估动态MRI血管图与DSA在侧支循环分级诊断中的准确性;以改良Rankin评分(mRS)为预后评估的依据,将AIS患者分为预后良好组(mRS评分≤2分)和预后不良组(mRS评分≥3分)两亚组,记录2组患者治疗后动态MRI参数差异,经Pearson相关系数分析AIS患者治疗后动态MRI参数与预后情况(m RS)的相关性。结果DSA检查显示,159例疑似AIS患者中确诊AIS者139例,动态MRI血管图确诊142例。动态MRI血管图对AIS诊断的准确度为95.60%(152/159),敏感度为98.56%(137/139),特异度为75.00%(15/20)。137例确诊AIS患者中,动态MRI血管图评估侧支循环分级显示0级32例,1级33例,2级29例,3级30例,4级13例,诊断准确率为93.43%(128/137),与金标准的一致性较高(Kappa=0.786)。治疗15 d后,预后良好组CBF显著高于预后不良组(P<0.05),MTT、TTP显著低于预后不良组(P<0.05)。Pearsaon相关性分析,CBF与mRS评分呈负相关,MTT、TTP与mRS评分呈正相关(P<0.05)。结论在AIS患者中,动态MRI血管图对侧支循环分级变化及对预后评估具有较高的诊断效能。Objective To investigate the changes of collateral circulation grading of dynamic MRI in patients with acute ischemic stroke(AIS)and its evaluated value on the prognosis.Methods The clinical data of 159 patients with suspected AIS who underwent dynamic MRI and DSA at the same time in Shangluo Central Hospital from January 2018 to December 2023 were retrospectively analyzed.DSA examination was used as the gold standard for diagnosis,and the diagnostic efficiency of dynamic MRI angiogram in AIS patients was analyzed.The accuracy of dynamic MRI angiogram and DSA in the diagnosis of collateral circulation grading was evaluated based on the results of DSA clinical staging.AIS patients were divided into the good prognosis group(mRS score≤2 points)and the poor prognosis group(mRS score≥3 points)by taking modified Rankin score(mRS)as prognosis assessment basis,and the differences in dynamic MRI parameters between the two groups after treatment were recorded.Pearson correlation coefficient was used to analyze the correlation between dynamic MRI parameters and prognosis status(mRS)in AIS patients after treatment.Results DSA examination results showed that 139 cases of AIS were diagnosed in 159 suspected AIS patients,and 142 cases were diagnosed by dynamic MRI angiogram.The accuracy,sensitivity and specificity of dynamic MRI angiogram in the diagnosis of AIS were 95.60%(152/159),98.56%(137/139)and 75.00%(15/20),respectively.Among the 137 patients diagnosed with AIS,the collateral circulation grading evaluated by dynamic MRI angiogram showed 32 cases of grade 0,33 cases of grade 1,29 cases of grade 2,30 cases of grade 3 and 13 cases of grade 4,and the diagnostic accuracy was 93.43%(128/137),which was highly consistent with the gold standard(Kappa=0.786).After 15 days of treatment,CBF in the good prognosis group was significantly higher than that in the poor prognosis group(P<0.05),while MTT and TTP were significantly lower than those in the poor prognosis group(P<0.05).Pearsaon correlation analysis showed that CBF was ne

关 键 词：急性缺血性脑卒中 侧支循环 动态磁共振成像 预后 诊断效能 

分 类 号：R743.33[医药卫生—神经病学与精神病学]