基于颅内动脉粥样硬化斑块特征和表观扩散系数直方图在预测缺血性脑卒中复发中的联合分析  

Combined analysis based on the characteristics of intracranial atherosclerotic plaque and apparent diffusion coefficient histogram in predicting the recurrence of ischemic stroke

作　　者：罗彤 高阳[1] 吴琼[1] 何金龙[1] 王泽华 LUO Tong;GAO Yang;WU Qiong;HE Jinlong;WANG Zehua(Department of Radiology,Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China)

机构地区：[1]内蒙古医科大学附属医院影像诊断科,呼和浩特010050

出　　处：《磁共振成像》2024年第12期94-100,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：内蒙古自治区自然科学基金项目(编号:2023QN08055);内蒙古自治区医疗卫生科技计划项目(编号:202201250)。

摘　　要：目的探讨症状性颅内动脉粥样硬化性狭窄患者的斑块特征和表观扩散系数(apparent diffusion coefficient,ADC)直方图在预测缺血性脑卒中复发中的应用。材料与方法本研究回顾性分析2022年6月至2024年6月期间于内蒙古医科大学附属医院就诊的114例前循环缺血性脑卒中患者病例资料,根据临床和影像资料将患者分为初发卒中组(n=56)和复发卒中组(n=58)。比较两组患者临床资料、ADC直方图参数和颅内粥样硬化斑块特征。采用多因素logistic回归分析模型分析缺血性脑卒中复发的独立危险因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析临床资料、ADC直方图参数、颅内粥样硬化斑块特征对缺血性脑卒中患者复发的预测价值。结果在114例前循环缺血性脑卒中患者中,56例为初发卒中,58例为复发卒中。初发卒中组和复发卒中组高同型半胱氨酸血症、ADCmin、峰度、颅内动脉粥样硬化斑块负荷、斑块强化率比较差异有统计学意义(P<0.05)。多因素logistic回归分析显示:峰度、斑块强化率、高同型半胱氨酸血症是缺血性脑卒中复发的独立危险因素(P<0.05)。Logistic回归模型的整体预测效能最佳(AUC=0.810,95%CI:0.734~0.887),高于任一单独预测因素,如斑块强化率(AUC=0.714,95%CI:0.619~0.808)、峰度(AUC=0.702,95%CI:0.607~0.796)。结论ADC直方图峰度、斑块强化率和高同型半胱氨酸血症与前循环缺血性脑卒中复发独立相关,将患者临床特征、ADC直方图与动脉粥样硬化斑块特征结合对前循环缺血性脑卒中复发具有较高的预测价值,能够为临床早期诊断和治疗提供相关技术支持。Objective:To explore the apparent diffusion coefficient(ADC)histogram and plaque characteristics of patients with symptomatic intracranial atherosclerotic stenosis in the prediction of ischemic stroke recurrence.Materials and Methods:This study retrospectively analyzed the clinical data of 114 patients with anterior circulation ischemic stroke who were treated in the Affiliated Hospital of Inner Mongolia Medical University from June 2022 to June 2024.According to clinical and imaging data,the patients were divided into initial stroke group(n=56)and recurrent stroke group(n=58).Compare two groups of patients with clinical data,ADC histogram parameters and characteristics of intracranial atherosclerotic plaque.Compare two groups of patients with clinical data,ADC histogram parameters and characteristics of intracranial atherosclerotic plaque.Using multivariable logistic regression model analysis of independent risk factors for recurrence of ischemic stroke,the receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of clinical data,ADC histogram parameters and intracranial atherosclerotic plaque characteristics for recurrence of ischemic stroke patients.Results:Among 114 patients with anterior ischemic stroke,56 had primary stroke and 58 had recurrent stroke.There were significant differences in hyperhomocysteinemia,ADCmin,kurtosis,intracranial atherosclerotic plaque load and plaque enhancement rate between the primary stroke group and the recurrent stroke group(P<0.05).Multivariate logistic regression analysis showed that kurtosis value,plaque enhancement rate and hyperhomocysteinemia were independent risk factors for ischemic stroke recurrence(P<0.05).Logistic regression model had the best overall predictive power(AUC=0.810,95%CI:0.734 to 0.887)were higher than any of the independent predictors,such as plaque enhancement rate(AUC=0.714,95%CI:0.619 to 0.808)and kurtosis value(AUC=0.702,95%CI:0.607 to 0.796).Conclusions:The kurtosis of ADC histogram,plaque area,plaque surface irregular

关 键 词：血管壁成像 脑卒中 卒中复发 易损斑块 磁共振成像 表观扩散系数直方图 

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]