摘要
目的以急性缺血性脑卒中患者低灌注强度比值(HIR)为侧支循环标准,探讨液体衰减反转恢复(FLAIR)血管高信号(FVH)与侧支循环间的相关性。方法回顾性分析2017年1月至2019年6月在本院就诊且行再灌注治疗(静脉溶栓/动脉取栓)的急性缺血性脑卒中患者252例,所有患者均于治疗前及治疗后行MRI(DWI、PWI)检查。FVH评分采用ASPECTS评分方法(0~7分)。HIR为脑血流达峰时间(Tmax)>10 s体积与Tmax>6 s体积的比值,根据HIR结果将患者分为侧支循环丰富组(HIR≤0.4)和侧支循环不丰富组(HIR>0.4)。应用Spearman等级相关分析及多元逻辑回归分析FVH与HIR间的相关性。结果侧支循环丰富组(n=126)FVH评分[4(3,6)]明显高于侧支循环不丰富组(n=126)[3(3,5)],差异有统计学意义(P=0.037)。252例患者中,FVH评分0~1分19例,2~3分62例,4~5分118例,6~7分53例。其中FVH 6~7分组HIR值最小[0.32(0.14,0.44)],预后良好比例最高(62.26%),各组间比较均有统计学差异(HIR值:P=0.045;预后良好比例:P=0.031)。Spearman相关分析显示FVH评分与HIR间呈负相关(r=-0.539;P<0.001)。逻辑回归分析显示PWI-DWI不匹配(OR 8.95,95%CI:2.65~30.22;P<0.001)、FVH评分(OR 34.20,95%CI:4.35~268.60;P=0.001)为预测HIR的独立预测因子。结论急性缺血性脑卒中患者再灌注治疗前丰富的FVH与低HIR密切相关。因此,当灌注数据或快速后处理软件不可用时,为了快速识别更有可能受益于再灌注治疗的患者,FVH可作为评估侧支循环的替代。
Objective To investigate the correlation between FLAIR vascular hyperintensities(FVH)and hypoperfusion intensity ratio(HIR)in acute ischemic stroke.Methods A total of 252 acute ischemic stroke patients receiving reperfusion therapy(intravenous thrombosis/arterial thrombectomy)from January 2017 to June 2019,were analyzed retrospectively in our study.All patients underwent MRI examination(DWI,PWI)before therapy and after therapy.FVH score was based on ASPECTS(0~7 scores).HIR was defined as the ratio of the time-to-maximum(Tmax)>10 s over Tmax>6 s lesion volumes.The median HIR was used to dichotomize good(HIR≤0.4)versus poor(HIR>0.4)collaterals.Spearman rank correlation and multiple logistic regression analysis were performed to evaluate the correlation between FVH and HIR.Results The FVH score in good collaterals group(n=126)(4(IQR,3-6))was significantly higher than that in poor collaterals group(n=126)(3(IQR,3-5)).Of the 252 patients,19 had 0-1 FVH score,62 had 2-3 score,118 had 4-5 score and 53 had 6-7 score.Among them,the HIR value in FVH 6-7 group was the lowest(0.32;IQR(0.14-0.44)),the good functional outcome rate was the highest(62.26%),there were statistical differences between the groups(HIR value:P=0.045;good functional outcome rate:P=0.031).Spearman rank correlation analysis showed that there was a negative correlation between FVH score and HIR(r=-0.539;P<0.001).Logistic regression analysis showed that PWI-DWI mismatch(OR(95%CI):8.95(2.65-30.22);P<0.001),FVH score(OR(95%CI):34.20(4.35-268.60);P=0.001)were independent predictors of HIR.Conclusion There is a close relationship between the abundance of FVH and the low HIR in patients with acute ischemic stroke before reperfusion therapy.Therefore,in order to quickly identify patients who are more likely to benefit from reperfusion therapy when perfusion data or rapid post-processing software are not available.The evaluation of FVH can be used as an alternative to collateral circulation.
作者
许海兵
沈孝翠
吉玉刚
辛春
温竞
XU Haibing;SHEN Xiaocui;JI Yugang(Jiangsu Vocational College of Medicine,P.R.China)
出处
《临床放射学杂志》
CSCD
北大核心
2020年第11期2175-2180,共6页
Journal of Clinical Radiology
关键词
卒中
磁共振成像
灌注加权成像
侧支循环
Stroke
Magnetic resonance imaging
Perfusion weighted imaging
Collateral circulation
