MRI-DWI定量参数及影像学征象预测老年急性脑出血短期预后价值  

Quantitative parameters and imaging signs of MMRI-DWI in predicting short-term prognosis of senile cerebral hemorrhage

作　　者：付恒 徐礼玲 李爽[3] FU Heng;XU Liling;LI Shuang(Department of Radiology,Zigong Mental Health Center,Zigong 643020,China;Department of Clinical Psychology,Zigong Mental Health Center,Zigong 643020,China;Department of Medical Imaging,Sichuan Provincial People's Hospital,Chengdu 610072,China)

机构地区：[1]四川省自贡市精神卫生中心放射科,四川自贡643020 [2]四川省自贡市精神卫生中心临床心理科,四川自贡643020 [3]四川省人民医院医学影像科,四川成都610072

出　　处：《医学影像学杂志》2024年第12期22-27,共6页Journal of Medical Imaging

基　　金：四川省医学(青年创新)科研课题项目(编号:S20043)。

摘　　要：目的探讨磁共振成像(MRI)-弥散加权成像(DWI)定量参数及影像学征象预测老年急性脑出血(AICH)短期预后的价值。方法选取102例老年AICH患者,入院时均行MRI-DWI检查获取定量参数[表观扩散系数(ADC)]及影像学征象,比较不同脑出血特征(出血部位、出血量、病情程度)患者ADC、影像学征象,分析ADC与脑出血特征的相关性。出院后3个月采用改良Rankin量表评分(mRS)评估患者预后,比较预后良好与预后不良患者临床资料、ADC,分析老年AICH患者预后不良的影响因素,并分析ADC及影响因素预测老年AICH患者预后不良的价值,比较含与不含ADC预测方案的预测效能。结果1)不同出血量、病情程度老年AICH患者ADC比较差异有统计学意义(P<0.05);2)ADC与出血量、病情程度呈负相关(P<0.05);3)预后不良患者出血量、术前NIHSS评分、出血破入脑室、早期神经功能恶化及术后肺部感染、应激性溃疡发生率高于预后良好患者,术前ADC低于预后良好患者,差异有统计学意义(P<0.05);4)术前ADC、出血破入脑室、早期神经功能恶化、术后肺部感染、应激性溃疡均为老年AICH患者预后不良的独立影响因素(P<0.05);5)术前ADC、出血破入脑室、早期神经功能恶化、术后肺部感染、应激性溃疡预测老年AICH患者预后不良的曲线下面积(AUC)分别为0.813、0.681、0.632、0.638、0.627;6)含ADC的预测方案(术前ADC、出血破入脑室、早期神经功能恶化、术后肺部感染、应激性溃疡联合)预测预后不良的AUC为0.932(95%CI:0.865~0.972),预测敏感度为97.37%,特异度为78.12%,与不含ADC的预测方案(出血破入脑室、早期神经功能恶化、术后肺部感染、应激性溃疡联合)比较,含ADC的预测方案的AUC明显增大(P<0.05)。结论MRI-DWI定量参数ADC在AICH患者短期预后方面具有一定价值,特别是与预后相关影响因素联合能提高预测效能。Objective To investigate the value of magnetic resonance imaging(MRI)-diffusion weighted imaging(DWI)quantitative parameters and imaging signs in predicting the short-term prognosis of acute intracerebral hemorrhage(AICH)in elderly patients.Methods A total of 102 elderly patients with AICH were selected in this work.Quantitative parameters[apparent diffusion coefficient(ADC)]and imaging signs were obtained by MMRI DWI examination upon admission.ADC and imaging signs of patients with different intracerebral hemorrhage characteristics(bleeding site,bleeding amount,and severity of disease)were compared.The correlation between ADC and cerebral hemorrhage was analyzed.The improved Rankin Scale(mRS)was used to evaluate the prognosis of patients 3 months after discharge.Clinical data and ADC of patients with good prognosis and poor prognosis were compared.The influencing factors of poor prognosis of elderly AICH patients were analyzed,and the value of ADC and its influencing factors in predicting poor prognosis of elderly AICH patients were analyzed.We compared the prediction performance of prediction schemes with and without ADC.Results 1)There were significant differences in ADC among elderly AICH patients with different blood loss and disease degree(P<0.05).2)ADC was negatively correlated with blood loss and disease severity(P<0.05).3)The incidence of blood loss,preoperative NIHSS score,hemorrhage into ventricle,early neurological deterioration,postoperative pulmonary infection and stress ulcer in patients with poor prognosis was higher than that in patients with good prognosis,and the incidence of preoperative ADC was lower than that in patients with good prognosis(P<0.05).4)Preoperative ADC,bleeding into the ventricle,early neurological deterioration,postoperative pulmonary infection and stress ulcer were independent factors of poor prognosis in elderly patients with AICH(P<0.05).5)The area under the curve(AUC)of preoperative ADC,bleeding into the ventricle,early neurological deterioration,postoperative pulmonary i

关 键 词：脑出血 磁共振成像 弥散加权成像 预后 预测 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]