摘要
目的探讨三维动脉自旋标记成像(3D-ASL)与数字减影血管造影(DSA)对急性缺血性脑卒中(AIS)患者闭塞部位和侧支循环(CC)的诊断价值。方法选择2019年1月至2020年6月在廊坊市中医医院就诊的53例大脑中动脉(MCA)闭塞AIS患者作为研究对象,所有患者均接受DSA和3D-ASL检查,以DSA金标准,观察3D-ASL近端动脉内信号(IAS)对闭塞部位的诊断价值,观察远端IAS诊断CC的临床价值,采用单因素及多因素logistic回归分析AIS患者预后不良的危险因素。结果DSA判断为CC良好共31例。以DSA为金标准,远端IAS诊断侧支循环状态的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为93.55%、81.82%、87.88%、90.00%和88.68%。DSA评估CC良好患者入院NIHSS评分低于CC不良患者,出院时预后良好率高于CC不良患者,差异均有统计学意义(均P<0.05)。CC良好和CC不良患者性别、年龄、房颤史、高血压、糖尿病、吸烟、饮酒、发病至治疗时间、治疗方法等临床资料比较差异均无统计学意义(均P>0.05)。单因素和多因素分析显示,ASL评估CC不良是AIS患者预后不良的风险因素(OR=5.897,P<0.05)。结论3D-ASL近端IAS和远端IAS可以分别为检测急性缺血性卒中患者的动脉闭塞部位和侧支循环灌注提供重要的诊断线索,通过3D-ASL检测CC对预后判定具有重要价值。
Objective To explore the diagnostic value of 3D-arterial spin labeling(ASL)and digital subtraction angiography(DSA)in the occlusion and collateral circulation(CC)of patients with acute ischemic stroke(AIS).Methods From January 2019 to June 2020,53 cases of AIS patients with middle cerebral artery(MCA)occlusion in Langfang Hospital of Traditional Chinese Medicine were selected as the research objects.All patients underwent DSA and 3D ASL examination.According to the gold standard of DSA,the diagnostic value of proximal intra-arterial signal(IAS)in 3D-ASL was observed,and the clinical value of distal IAS in the diagnosis of lateral CC was observed.Univariate and multivariate logistic regression were used to identify risk factors for poor outcome in AIS patients.Results There were 31 cases with good collateral circulation judged by DSA.Taking DSA as the gold standard,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of digital IAS in diagnosing CC status were 93.55%,81.82%,87.88%,90.00%and 88.68%,respectively.The National Institutes of Health Stroke Scale(NIHSS)score of patients with good CC assessed by 3D-ASL was lower than that of patients with poor CC at admission,and the good prognosis rate at discharge was higher than that of patients with poor CC,with statistically significant difference(all P<0.05).There was no significant difference in clinical data between patients with good CC and those with poor CC,such as gender,age,history of atrial fibrillation,hypertension,diabetes,smoking,drinking,onset to treatment time,treatment methods,etc(all P>0.05).Univariate and multivariate analysis showed that poor CC assessed by ASL was a risk factor for poor prognosis in AIS patients(OR=5.897,P<0.05).Conclusions The proximal and distal IAS of 3D-ASL can provide important diagnostic clues for detecting arterial occlusion and collateral perfusion in patients with AIS,and the detection of CC by ASL is of great value for prognosis.
作者
孙福祥
张哲
张琳
Sun Fuxiang;Zhang Zhe;Zhang Lin(Department of CT/MR,Langfang Hospital of Traditional Chinese Medicine,Langfang 065000,China;Department of CT/MR,Langfang People′Hospital,Langfang 065000,China)
出处
《中国医师杂志》
CAS
2023年第1期81-85,91,共6页
Journal of Chinese Physician
基金
廊坊市科技支撑计划项目(2019013021)。
关键词
缺血性卒中
侧支循环
动脉自旋标记
磁共振血管造影术
血管造影术
数字减影
Ischemic stroke
Collateral circulation
Arterial spin labeling
Magnetic resonance angiography
Angiography,digital subtraction
