Zhongguo cuzhong zazhi (Jul 2019)
磁敏感加权成像不对称皮层静脉征与急性缺血性卒中预后的关系研究 Predictive Value of Asymmetrical Cortical Vein Sign Based on Susceptibility Weighted Imaging for Prognosis of Patients with Acute Ischemic Stroke
Abstract
【摘要】 目的 探究SWI不对称皮层静脉征（asymmetrical cortical vein sign，ACVS）的相关因素及其对急性缺血性卒中预后的预测价值。 方法 连续收集2016年11月-2017年11月在河北医科大学第三医院住院的急性大脑中动脉（middle cerebral artery，MCA）供血区梗死的患者125例。所有患者均在发病后7 d内完成头颅MRI检查中的DWI、SWI及时间飞跃法（time of flight，TOF）MRA序列，并对ACVS、MCA狭窄程度和脑梗死范围进行评价。采用NIHSS评分评价患者基线神经功能受损情况，采用mRS评分对患者发病3个月时预后进行评估。将患者分为ACVS组和皮层静脉显影对称组。比较两组人口学信息、临床和影像信息，并通过Logistic回归分析评估ACVS对卒中预后的预测价值。 结果 在入组的125例患者中，95例（76.0%）SWI表现为显影程度对称的皮层静脉，30例（24.0%）SWI可见ACVS。与皮层静脉显影对称组相比，ACVS组患者MCA重度狭窄或闭塞更为常见（76.7% vs 45.3% P=0.003），Alberta卒中项目早期CT评分（Albert stroke program early CT score，ASPECTS）较低（7.5分 vs 8.0分，P=0.018），入院NIHSS评分较高（4.5分 vs 4.0分，P=0.042）；两组患者的3个月不良预后情况（mRS评分＞1分）差异无统计学意义（63.3% vs 44.2%，P=0.093）。调整干扰因素后，Logistic回归显示ACVS不是患者3个月预后不良的独立预测因素。 结论 ACVS的存在与卒中患者MCA的狭窄程度、DWI病灶大小及入院时神经功能受损严重程度有关，但不能独立预测患者的3个月预后。 【Abstract】 Objective To evaluate the predictive value of asymmetrical cortical vein sign (ACVS) based on SWI for clinical outcome at 3 months in patients with acute ischemic stroke (AIS). Methods Data of AIS patients with infarction in middle cerebral artery (MCA) territory from Department of Neurology, the Third Hospital of Hebei Medical University were collected. All patients underwent DWI, SWI and time of flight (TOF) MRA examination within 7 days after symptom onset, and ACVS, the degree of MCA stenosis and infarct size in all patients were evaluated. Stroke severity on admission was assessed by NIHSS, and the outcome at 3 months was assessed by mRS. Based on the SWI findings, the patients were divided into ACVS group and symmetrical cortical venous group. Univariate analysis and multivariate logistic regression analysis were used to evaluate the value of ACVS in predicting the 3-month prognosis. Results A total of 125 patients were enrolled in this study, with symmetrical cortical venous in 95 (76.0%) patients and ACVS in 30 (24.0%) patients. Compared with symmetrical cortical venous group, MCA severe stenosis or occlusion were more common (76.7% vs 45.3%, P=0.003), DWIASPECTS score was lower (7.5 vs 8.0, P=0.018), and NIHSS score on admission was higher (4.5vs 40, P=0.042) in ACVS group. There was no significant difference in 3-month outcome between the two groups (63.3% vs 44.2%, P=0.093). After adjusting for the confounding factors, logistic regression analysis indicated ACVS was not an independent predictive factor of the 3-month outcome in AIS patients. Conclusions ACVS is related to the degree of MCA stenosis, infarct size and NIHSS score on admission in AIS patients, but it can’t independently predict the prognosis at 3 months after stroke onset.
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