摘要
目的以急性缺血性脑卒中患者数字减影血管造影(digital subtraction angiography,DSA)为侧支循环标准,探讨低灌注强度比值(hypoperfusion intensity ratio,HIR)与侧支循环间的相关性。材料与方法回顾性分析2017年1月至2020年3月就诊且行机械取栓的急性缺血性脑卒中患者100例,所有患者均于治疗前行MRI[扩散加权成像(diffusion weighted imaging,DWI)、灌注加权成像(perfusion weighted imaging,PWI)]检查。侧支循环评分采用美国介入与治疗学会神经放射治疗学(American Society of Interventional and Therapeutic Neuroradiology,ASITN)分级系统评估,ASITN 0~2级为侧支循环不丰富,ASITN 3~4级为侧支循环丰富。HIR为脑血流达峰时间(Tmax)>10 s体积与Tmax>6 s体积的比值。应用Spearman等级相关分析及ROC曲线分析HIR与侧支循环间的相关性。结果侧支循环丰富组(ASITN 3~4级)(51例)Tmax>6 s体积[(91.62±12.40)ml与(125.73±17.91)ml]、Tmax>10 s体积[(26.14±17.74)ml与(58.23±29.96)ml]、PWI-DWI不匹配体积[(72.52±10.08)ml与(89.63±14.60)ml]及HIR值(0.33±0.08与0.43±0.09)明显小于侧支循环不丰富组(ASITN 0~2级)(49例),差异有统计学意义(t=9.547,P=0.007;t=7.596,P<0.001;t=7.118,P=0.016;t=-5.753,P<0.001)。Spearman相关分析显示HIR值与ASITN分级间呈负相关(r=-0.672;P<0.001)。受试者操作曲线(receiver operating characteristic,ROC)分析显示HIR预测卒中侧支循环(ASITN分级)的曲线下面积为0.801(95%CI:0.714~0.888)。当HIR的最佳临界值为0.40时,预测卒中侧支循环(ASITN分级)的敏感度和特异度分别为77.60%和74.51%。结论急性缺血性脑卒中患者机械取栓治疗前低HIR与丰富的侧支循环密切相关。与金标准DSA相比,HIR是一个可靠的侧支循环测量指标,HIR<0.4是预测卒中良好侧支循环的最佳值。
Objective:To investigate the correlation between hypoperfusion intensity ratio(HIR)and collateral circulation using digital subtraction angiography(DSA)in acute ischemic stroke.Materials and Methods:A total of 100 acute ischemic stroke patients receiving endovascular thrombectomy therapy in our study from January 2017 to March 2020 were analyzed retrospectively.All patients underwent MRI examination[diffusion weighted imaging(DWI)],perfusion weighted imaging(PWI)before therapy.American Society of Interventional and Therapeutic Neuroradiology(ASITN)grading system was used to evaluate the collateral circulation.ASITN 0-2 grade was poor collateral circulation and ASITN 3-4 was good collateral circulation.HIR was defined as the ratio of the time-to-maximum(Tmax)>10 s over Tmax>6 s lesion volumes.The difference was statistically significant(t=9.547,P=0.007;t=7.596,P<0.001;t=7.118,P=0.016;t=-5.753,P<0.001).Spearman rank correlation and ROC analysis were performed to evaluate the correlation between HIR and collateral circulation.Results:The Tmax>6 s(91.62±12.40 vs 125.73±17.91),Tmax>10 s(26.14±17.74 vs 58.23±29.96),PWI-DWI mismatch volume(72.52±10.08 vs 89.63±14.60)and HIR value(0.33±0.08 vs 0.43±0.09)in good collaterals group(ASITN 3-4)(n=51)was significantly lower than those in poor collaterals group(ASITN 0-2)(n=49).Spearman rank correlation analysis showed that there was a negative correlation between HIR and ASITN(r=-0.672;P<0.001).ROC analysis showed that the area under the curve of HIR predicting acute stroke collateral circulation was 0.801(95%CI:0.714-0.888).When the optimal cut-off value of HIR was 0.40,the sensitivity and specificity for predicting collateral circulation was 77.60%and 74.51%respectively.Conclusions:There is a close relationship between the low HIR and good collateral circulation in patients with acute ischemic stroke before endovascular thrombectomy therapy.Compared with gold standard DSA,HIR is a reliable measurement index of collateral circulation,and HIR<0.4 is the best predicted
作者
徐佳
彭明洋
周文珍
王同兴
赵晓静
周星帆
殷信道
丁力
XU Jia;PENG Mingyang;ZHOU Wenzhen;WANG Tongxing;ZHAO Xiaojing;ZHOU Xingfan;YIN Xindao;DING Li(Department of Radiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 21006,China)
出处
《磁共振成像》
CAS
2020年第11期971-974,1055,共5页
Chinese Journal of Magnetic Resonance Imaging
基金
江苏省科技发展计划项目(编号:BE2017614)
南京市卫计委医药卫生科研项目(编号:YKK18101)。
关键词
卒中
磁共振成像
扩散加权成像
灌注加权成像
stroke
magnetic resonance imaging
diffusion weighted imaging
perfusion weighted imaging
