摘要
目的探讨三维动脉自旋标记(3D-ASL)灌注成像预测急性缺血性脑卒中(AIS)患者静脉溶栓后早期神经功能改善的价值。方法回顾性分析60例经静脉溶栓治疗的AIS患者,治疗后均行扩散加权成像(DWI)及3D-ASL检查,根据梗死区脑组织再灌注情况分为良好灌注组和低灌注组。采用独立样本t检验、非参数检验、卡方检验或Fisher精确概率法对比分析两组的临床指标。将出院时NIHSS评分减少≥4分或完全性神经功能恢复定义为早期神经功能改善(ENI),采用多因素Logistic回归分析,探讨预测ENI的有效临床及灌注指标,并进行ROC曲线分析。结果静脉溶栓后,3D-ASL良好灌注组患者31例,23例(74.2%)获得ENI;低灌注组29例,11例(37.9%)获得ENI。与低灌注组相比,良好灌注组患者的出院NIHSS评分更低(P=0.012)、NIHSS评分下降更多(P=0.001)、获得ENI的比例更高(P=0.005)。多因素Logistic回归分析显示:3D-ASL良好灌注是预测ENI的独立指标(OR=3.932;95%CI:1.198~12.911,P=0.024),ROC曲线下面积为0.684,敏感度67.6%,特异度69.2%。结论3D-ASL良好灌注可作为预测AIS患者早期神经功能改善的有效影像学标志物。
Objective To investigate the value of three-dimensional arterial spin labeling(3D-ASL)MRI in predicting the early neurological improvement(ENI)after intravenous thrombolysis in patients with acute ischemic stroke(AIS).Methods Sixty patients with AIS were retrospectively analyzed.All the patients were treated by intravenous thrombolysis and then underwent MRI,including diffusion weighted imaging(DWI)and 3D-ASL.They were divided into group 1 with good reperfusion and group 2 with poor reperfusion based on the microvascular reperfusion status of ischemic lesions on 3D-ASL.The clinical factors were compared between two groups using independent t test,non-parametric test,chi-square or fisher's exact test as appropriate.The ENI was defined as a decrease in the score of National Institutes of Health Stroke Scale(NIHSS)by≥4 points or a complete resolution of neurological deficits after thrombolysis at discharge.Multivariable logistic regression model was constructed to investigate the potential effective predictor of ENI.Receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic performance of the parameters.Results After intravenous thrombolysis,good reperfusion was found in 31 patients(group 1),23(74.2%)of which had ENI;while poor reperfusion was observed in 29 patients(group 2),11(37.9%)of which had ENI.The patients in group 1 had lower NIHSS scores(P=0.012),more decrease in NIHSS scores(P=0.001)and more proportion of ENI(P=0.005)at discharge when compared with those in group 2.Multivariable logistic regression showed that good reperfusion on 3D-ASL was an independent predictor for ENI(OR=3.932;95%CI:1.198-12.911,P=0.024).The area under the ROC curve was 0.684,with a sensitivity of 67.6%and a specificity of 69.2%.Conclusion The 3D-ASL could accurately reflect the microvascular reperfusion status after intravenous thrombolysis.Good reperfusion on ASL was independently associated with ENI and might be an effective imaging marker for predicting ENI in patients with AIS.
作者
沈子祯
任舒静
吴蓉蓉
蒋雷
王瑶
施海彬
鲁珊珊
洪汛宁
SHEN Zizhen;REN Shujing;WU Rongrong(Department of Radiology,The First Affliated Hospital of Nanjing Medical University,Nanjing,Jiangsu Province 210029,P.R.China)
出处
《临床放射学杂志》
北大核心
2023年第7期1076-1080,共5页
Journal of Clinical Radiology
基金
国家自然科学基金资助项目(编号:82171907)。
关键词
动脉自旋标记
缺血性脑卒中
静脉溶栓
临床预后
Arterial spin labeling
Ischemic stroke
Intravenous thrombolysis
Prognosis
