QSM联合SWI预测急性缺血性脑卒中患者EVT后神经功能的价值  

Predictive value of QSM combined with SWI in neurological function of patients with acute ischemic stroke after endovascular treatment

作　　者：李小勇 郭海志 赵洋 Li Xiaoyong;Guo Haizhi;Zhao Yang(Department of Neurology,Ziyang Central Hospital,Ziyang 641300,China;Department of Medical Imaging,Ziyang Central Hospital,Ziyang 641300,China)

机构地区：[1]资阳市中心医院神经内科,四川资阳641300 [2]资阳市中心医院医学影像科,四川资阳641300

出　　处：《中华脑血管病杂志(电子版)》2024年第6期549-555,共7页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：四川省基层卫生事业发展研究中心2022年立项项目(SWFZ22-C-100)。

摘　　要：目的探讨定量磁敏感成像(QSM)联合磁敏感加权成像(SWI)预测急性缺血性脑卒中(AIS)患者血管内治疗(EVT)后神经功能的价值。方法纳入2020年2月至2023年10月四川省资阳市中心医院神经内科收治的169例AIS患者为研究对象,入院时采集患者人口学资料以及影像学检查结果。所有患者均接受EVT,治疗结束会对患者进行为期3个月的随访,根据改良Rankin量表(mRS)评分将患者分为神经功能良好组(mRS评分≤2分)和不良组(mRS评分>2分)。采用多因素Logistic回归分析影响患者神经功能的因素,绘制受试者工作特征曲线(ROC),分析QSM联合SWI对患者神经功能的预测价值。结果最终纳入156例患者,99例为神经功能良好组,57例神经功能不良组;神经功能良好组患者入院美国国立卫生研究院卒中量表(NIHSS)评分低于神经功能不良者(P<0.05);神经功能良好组QSM的变异系数(CV)、中位数、最大值、最小值高于神经功能不良组,平均值高于神经功能不良组,病灶体积、磁敏感血管征(SVS)直径和SVS阳性占比低于神经功能不良组(P<0.05),差异均有统计学意义;2组偏度、峰度以及标准差组间对比差异无统计学意义(P>0.05);以治疗后mRS评分为因变量(1=不良,0=良好),将上述差异具有统计学意义的指标作为自变量进行多因素Logistic分析,结果显示CV(OR=3.574,95%CI:1.228~10.400)、中位数(OR=0.018,95%CI:0.001~0.621)、病灶体积(OR=1.125,95%CI:1.024~1.235)、SVS阳性(OR=55.304,95%CI:1.609~1900.426)、SVS直径(OR=1.287,95%CI:1.032~1.604)均是预测术后神经功能的因素(P<0.05);ROC曲线显示SVS阳性、SVS直径、CV、病灶体积以及中位数对术后患者神经功能的曲线下面积(AUC)分别为0.616、0.836、0.859、0.803、0.867,且QSM和SWI联合的AUC(0.985)高于单一的(0.935和0.912)(P<0.05)。结论QSM参数CV、中位数以及SWI参数SVS阳性、SVS直径、病灶体积均是影响术后患者神经功能的相关因素,对患者�Objective To explore the predictive value of quantitative susceptibility mapping(QSM)combined with susceptibility weighted imaging(SWI)for neurological function in patients with acute ischemic stroke(AIS)after endovascular treatment(EVT).Methods One hundred and sixty nine AIS patients admitted to our hospital from February 2020 to October 2023 were included.Demographic data and imaging examination results of patients were collected at admission.All patients undewent EVT and were followed up for 3 months after treatment.Patients were categorized into two groups based on the modified Rankin Scale(mRS)score:good neurological function group(mRS≤2)and poor neurological function group(mRS>2).Multivariate Logistic regression was used to analyze the factors influencing patients&apos;neurological function,and receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of QSM combined with SWI on neurological function.Results A total of 156 patients were included,comprising 99 patients with good prognosis and 57 with poor prognosis.The NIHSS score was significantly higher in patients with good neurological function compared to those with poor neurological function(P<0.05).The coefficient of variation(CV),median,maximum,and minimum value of QSM were higher in patients with good neurological function,with the average value also being higher than in those with poor neurological function.Lesion volume,the diameter of magnetic sensitive vessel sign(SVS),and the SVS positivity were lower than those in patients with poor neurological function(P<0.05).There was no significant difference in skewness,kurtosis and standard deviation between the two groups(P>0.05).In multivariate Logistic analysis,with mRS score as the dependent variable(1=good,0=bad),the CV(OR=3.574,95%CI:1.228-10.400),median(OR=0.018,95%CI:0.001-0.621),lesion volume(OR=1.125,95%CI:1.024-1.235),SVS positivity(OR=55.304,95%CI:1.609-1900.426),and SVS diameter(OR=1.287,95%CI:1.032-1.604)were all predictive factors for postoperative neurologi

关 键 词：定量磁敏感成像 磁敏感加权成像 急性缺血性脑卒中 血管内治疗 神经功能 预测价值 

分 类 号：R743.3[医药卫生—神经病学与精神病学]