IVIM成像对单侧大脑中动脉闭塞性急性脑卒中的临床预后相关性研究  

Clinical prognosis correlation of intravoxel incoherent motion diffusion imaging in magnetic resonance voxel on unilateral middle cerebral artery occlusion acute stroke

作　　者：辛奕 周莹 薛明琛 张亚运 周芯羽 XIN Yi;ZHOU Ying;XUE Ming-chen;ZHANG Ya-yun;ZHOU Xin-yu(Department of Radiology,The First Affiliated Hospital of Kangda College of Nanjing Medical University,The First People’s Hospital of Lianyungang,Lianyungang 222002,Jiangsu,China)

机构地区：[1]南京医科大学康达学院附属连云港市第一人民医院影像科,江苏连云港222000

出　　处：《生物医学工程与临床》2025年第2期166-171,共6页Biomedical Engineering and Clinical Medicine

基　　金：连云港市卫生科技项目(ZD202202);南京医科大学康达学院科研发展基金重点项目(KD2023KYJJ033)。

摘　　要：目的探讨3.0 T磁共振体素内不相干运动扩散(IVIM)成像与单侧大脑中动脉闭塞性急性脑卒中临床预后的相关性。方法选择2021年1月至2022年1月在连云港市第一人民医院收治的单侧大脑中动脉闭塞性急性脑卒中患者52例,其中男性29例,女性23例;年龄54~76岁,平均年龄64.36岁;身体质量指数(BMI)17~33 kg/m^(2),平均BMI 24.5 kg/m^(2)(标准差2.3 kg/m^(2));吸烟史16例,饮酒史9例;糖尿病20例,高血压33例,心房颤动29例;梗死侧别,左侧26例,右侧26例。按照出院后90 d时改良Rankin量表(mRS)评分,将患者分为预后良好组(mRS评分≤2分)和预后不良组(3分≤mRS评分≤6分)。比较两组的表观扩散系数(ADC)、灌注分数(f)、扩散系数(D)和伪扩散系数(D*),采用Logistics回归模型分析IVIM成像各参数与预后结局的相关性,并应用受试者工作特性(ROC)曲线分析IVIM成像各参数对单侧大脑中动脉闭塞性急性脑卒中患者预后不良的预测效能。结果根据出院后90 d时mRS评分分为预后良好组25例和预后不良组27例。ADC、f、D在预后不良组与预后良好组间差异有统计学意义[(0.43±0.16)×10^(-3) mm^(2)/s vs(0.52±0.13)×10^(-3) mm^(2)/s、0.23±0.05 vs 0.27±0.08、(0.39±0.13)×10^(-3) mm^(2)/s vs(0.49±0.11)×10^(-3) mm^(2)/s。P<0.05];两组D*差异无统计学意义(P>0.05)。Logistics分析结果显示,单侧大脑中动脉闭塞性急性脑卒中患者ADC[比值比(OR)=0.003,95%可信区间(CI)=0.000~0.483,P=0.025]、f(OR=0.001,95%CI=0.000~0.690,P=0.038)、D(OR=0.001,95%CI=0.000~0.353,P=0.022)与其预后不良结局呈负相关性,D*与其预后不良结局无明显相关性(P=0.574);ADC、f、D及各参数联合预测预后不良的曲线下面积(AUC)分别为0.677(95%CI=0.533~0.800)、0.691(95%CI=0.548~0.812)、0.713(95%CI=0.571~0.830)、0.810(95%CI=0.678~0.906),灵敏度分别为48.00%、68.00%、56.00%、68.00%,特异度分别为85.19%、77.78%、81.48%,截断值分别为≤0.40×10^(-3) mm^(2)/s、≤0.23、�Objective To investigate the correlation between 3.0 T magnetic resonance introvoxel incoherent motion(IVIM)imaging and clinical prognosis of acute stroke with unilateral middle cerebral artery occlusion.Methods From January 2021 to January 2022,a total of 52 patients with acute stroke caused by unilateral middle cerebral artery occlusion were enrolled,which included 29 males and 23 females,aged 54-76 years old with mean age of 64.36 years old;body mass index(BMI)was 17-33 kg/m^(2) with mean BMI of 24.5 kg/m^(2)(standard deviation 2.3 kg/m^(2));16 cases of smoking history and 9 of drinking history;20 cases of diabetes,33 of hypertension and 29 of atrial fibrillation;26 cases of left infarction and 26 of right infarction.According to modified Rankin scale(mRS)score at 90 days after discharge,all of the patients were divided into good prognosis group(mRS score≤2,n=25)and poor prognosis group(3≤mRS score≤6,n=27).The apparent diffusion coefficient(ADC),perfusion fraction(f),diffusion coefficient(D)and pseudo-diffusion coefficient(D*)were compared between 2 groups.The Logistic regression model was used to analyze the correlation between IVIM imaging parameters and prognosis,and receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of IVIM imaging parameters on poor prognosis of patients with acute stroke of unilateral middle cerebral artery occlusion.Results There were significant differences in ADC,f and D between poor prognosis group and good prognosis group[(0.43±0.16)×10^(-3) mm^(2)/s vs(0.52±0.13)×10^(-3) mm^(2)/s,0.23±0.05 vs 0.27±0.08,(0.39±0.13)×10^(-3) mm^(2)/s vs(0.49±0.11)×10^(-3) mm^(2)/s.P<0.05];there was no significant difference in D*between 2 groups(P>0.05).Logistic analysis results showed that ADC[odds ratio(OR)=0.003,95%confidence interval(CI)=0.000-0.483,P=0.025],f(OR=0.001,95%CI=0.000-0.690,P=0.038)and D(OR=0.001,95%CI=0.000-0.353,P=0.022)were negatively correlated with poor prognosis in acute stroke patients with unilateral middle cerebral artery o

关 键 词：磁共振 体素不相干运动扩散成像 大脑中动脉闭塞 急性脑卒中 临床预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]