基于MR 3D-ASL联合DWI定量参数对急性缺血性脑卒中患者血管内治疗后预后不良的危险因素分析  

Analysis of risk factors for poor prognosis after endovascular treatment of acute ischemic stroke based on MR 3D-ASL combined with DWI

作　　者：李昌 王伟 陈玉昆 高明勇[2] 冯国洋 王娟[1] 哈婷婷 亓立强 Li Chang;Wang Wei;Chen Yukun;Gao Mingyong;Feng Guoyang;Wang Juan;Ha Tingting;Qi Liqiang(Department of Radiology,Beijing Rehabilitation Hospital Affiliated of Capital Medical University,Beijing 100144,China;Department of Radiology,Foshan First People's Hospital,Foshan 528000,China)

机构地区：[1]首都医科大学附属北京康复医院放射科,北京100144 [2]佛山市第一人民医院放射科,佛山528000

出　　处：《中华解剖与临床杂志》2025年第1期29-35,共7页Chinese Journal of Anatomy and Clinics

摘　　要：目的基于MR三维动脉自旋标记(3D-ASL)联合弥散加权成像(DWI)定量参数探讨急性缺血性脑卒中(AIS)患者血管内治疗后预后不良的危险因素。方法病例对照研究。纳入2021年1月—2023年12月首都医科大学附属北京康复医院AIS患者80例, 其中男42例、女38例, 年龄60~74(67.1±5.2)岁。入院后患者行头颅MRI检查, 扫描序列包括 DWI和双参数3D-ASL。患者均行血管内治疗, 治疗后第90 天采用改良Rankin量表(mRS)评估预后并分组, mRS评分≤2分为预后良好组(45例), mRS评分>2分为预后不良组(35例)。观察指标:对2组患者性别、年龄、体质量指数、病灶侧别、病变部位、梗死面积、入院时美国国立卫生研究院卒中量表(NIHSS)评分、合并疾病、饮酒史、吸烟史等临床基线资料, 以及MR 3D-ASL联合DWI检查的定量参数表观弥散系数(ADC)、相对表观弥散系数(rADC)、脑血流量(CBF)、相对脑血流量(rCBF)等, 进行单因素分析, 选取单因素分析中P<0.05的指标进一步采用多因素logistic回归分析ASI血管内治疗后预后不良的独立危险因素。结果单因素分析:预后不良组患者脑梗死面积(13.21±1.18)cm^(2)、NIHSS评分(10.9±1.2)分, 分别高于预后良好组的(7.29±1.13)cm^(2)、(6.5±1.1)分, 差异均有统计学意义(t=22.80、17.30, P值均<0.001), 其他临床基线资料比较差异均无统计学意义(P值均>0.05);预后不良组MR 3D-ASL联合DWI定量参数ADC、rADC、CBF、rCBF分别为(0.35±0.09)×10^(-3) mm^(2)/s、(0.45±0.09)×10^(-3) mm^(2)/s、(23.13±4.69)mL·100 g^(-1)·min^(-1)、(0.45±0.13)mL·100 g^(-1)·min^(-1), 分别低于预后良好组的(0.72±0.16)×10^(-3) mm^(2)/s、(0.54±0.13)×10^(-3) mm^(2)/s、(43.61±6.25)mL·100 g^(-1)·min^(-1)、(0.68±0.11)mL·100 g^(-1)·min^(-1), 差异均有统计学意义(P值均<0.05)。多因素logistic回归分析:梗死面积(OR=16.564, 95%CI:2.985~91.915)、入院时NIHSS评分(OR=11.264, 95%CI:2.648~47.915)、ADC(OR=6.214, 95%Objective:This study aimed to explore the risk factors for poor prognosis after endovascular treatment of acute ischemic stroke(AIS)by using MR three-dimensional arterial spin labeling(3D-ASL)combined with diffusion-weighted imaging(DWI).Methods:This study was a case-control study.Clinical data of 80 patients with AIS admitted to Beijing Rehabilitation Hospital Affiliated to Capital Medical University from January 2021 to December 2023 were included,including 42 males and 38 females,aged 60-74(67.1±5.2)years.After admission,the patients underwent head MRI examination,which included DWI and dual parameter 3D-ASL scanning sequences.All patients underwent endovascular treatment,and 90 days after treatment,the modified Rankin Scale(mRS)was used to evaluate prognosis and group the patients.An mRS score≤2 was classified as the good prognosis group(45 cases),and an mRS score>2 was classified as the poor prognosis group(35 cases).Observation indicators:Univariate analysis was conducted on clinical baseline data,such as gender,age,body mass index,lesion location,lesion site,infarct area,National Institutes of Health stroke scale(NIHSS)score at admission,comorbidities,alcohol consumption history,and smoking history,and quantitative parameters of apparent diffusion coefficient(ADC),relative apparent diffusion coefficient(rADC),cerebral blood flow(CBF),and relative cerebral blood flow(rCBF)in MR 3D-ASL combined with DWI examinations for the two groups.The indicators with P<0.05 in the univariate analysis were further analyzed using multivariate logistic regression to identify the independent risk factors for poor prognosis after ASI endovascular treatment.Results:Univariate analysis results:The infarct area(13.21±1.18)cm^(2) and NIHSS score(10.9±1.2)point in the poor prognosis group were higher than those in the good prognosis group([7.29±1.13]cm^(2) and(6.5±1.1)point,respectively),and the differences were statistically significant(t=22.80 and 17.30,all P values<0.001).No statistically significant difference was found

关 键 词：卒中 急性缺血性卒中 磁共振成像 三维动脉自旋标记 弥散加权成像 血管内治疗 预后评估 危险因素 

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]