中华神经医学杂志
中華神經醫學雜誌
중화신경의학잡지
CHINESE JOURNAL OF NEUROMEDICINE
2015年
3期
265-270
,共6页
张卫%朱幼玲%吴晓宇%朱双根%翟登月
張衛%硃幼玲%吳曉宇%硃雙根%翟登月
장위%주유령%오효우%주쌍근%적등월
磁共振成像%液体衰减反转恢复序列%血管高信号征%脑梗死,急性%大动脉粥样硬化型
磁共振成像%液體衰減反轉恢複序列%血管高信號徵%腦梗死,急性%大動脈粥樣硬化型
자공진성상%액체쇠감반전회복서렬%혈관고신호정%뇌경사,급성%대동맥죽양경화형
Magnetic resonance imaging%Fluid attenuated inversion recovery%Vascular hyperintensity%Acute cerebral infarction%Atherosclerosis
目的 探讨MRI液体衰减反转恢复(FLAIR)序列血管高信号征评估急性前循环脑梗死患者的血管狭窄程度和病情严重程度的可行性. 方法 选择自2013年5月至2014年5月连续入住安徽医科大学第三附属医院神经内科的急性前循环脑梗死患者340例,所有患者均完成相关MRI检查,包括磁共振扩散加权成像(DWI)、FLAIR及颈部、头颅磁共振血管成像(MRA).根据FLAI序列血管高信号征出现与否将患者分为无血管高信号征组和有血管高信号征组,比较2组的基本临床资料、血管学指标及病情严重程度,应用受试者工作特征曲线(ROC)计算血管高信号征诊断血管严重狭窄和闭塞的灵敏度、特异度,分析血管高信号征对新TOAST分型中大动脉粥样硬化型急性脑梗死患者病情严重程度的评估价值. 结果 340例急性前循环脑梗死患者中有109例(32.1％)存在血管高信号征.在TOAST分型构成比及血管狭窄程度分级方面,无血管高信号征组和有血管高信号征组间差异存在统计学意义(P＜0.05),其中有血管高信号征组以大动脉粥样硬化型所占比率最大(82.6％),而无血管高信号征组以小血管病变型为主(56.3％);有血管高信号征组血管严重狭窄及闭塞所占比率明显高于无血管高信号征组(34.9％vs 5.6％,39.5％vs 0.9％),Spearman等级相关分析显示颈动脉-大脑中动脉血管狭窄程度与血管高信号征存在正相关关系(r=0.599,P=0.000).与无血管高信号征组相比,有血管高信号征组的梗死体积更大,入院24h内美国国立卫生研究院卒中量表(NIHSS)评分更高,差异均有统计学意义(P＜0.05).ROC曲线显示血管高信号征诊断血管严重狭窄的灵敏度为84.38％、特异度为88.52％[曲线下面积(AUC)=0.892,95％CI:0.85～0.94,P＜0.05],诊断血管闭塞的灵敏度为88.89％、特异度为85.76％(AUC=0.929,95％CI:0.89～0.97,P＜0.05).在大动脉粥样硬化型急性脑梗死患者(148例)中的狭窄率70％～99％及狭窄率100％亚组中,血管高信号征评分高者的梗死体积较评分低者更小,神经功能缺损程度较评分低者更轻,差异均有统计学意义(P＜0.05). 结论 FLAIR序列血管高信号征可以用来评估血管严重狭窄或闭塞,且在大动脉粥样硬化型急性脑梗死患者中,血管严重狭窄及闭塞患者的血管高信号征评分越高,病情程度越轻.
目的 探討MRI液體衰減反轉恢複(FLAIR)序列血管高信號徵評估急性前循環腦梗死患者的血管狹窄程度和病情嚴重程度的可行性. 方法 選擇自2013年5月至2014年5月連續入住安徽醫科大學第三附屬醫院神經內科的急性前循環腦梗死患者340例,所有患者均完成相關MRI檢查,包括磁共振擴散加權成像(DWI)、FLAIR及頸部、頭顱磁共振血管成像(MRA).根據FLAI序列血管高信號徵齣現與否將患者分為無血管高信號徵組和有血管高信號徵組,比較2組的基本臨床資料、血管學指標及病情嚴重程度,應用受試者工作特徵麯線(ROC)計算血管高信號徵診斷血管嚴重狹窄和閉塞的靈敏度、特異度,分析血管高信號徵對新TOAST分型中大動脈粥樣硬化型急性腦梗死患者病情嚴重程度的評估價值. 結果 340例急性前循環腦梗死患者中有109例(32.1％)存在血管高信號徵.在TOAST分型構成比及血管狹窄程度分級方麵,無血管高信號徵組和有血管高信號徵組間差異存在統計學意義(P＜0.05),其中有血管高信號徵組以大動脈粥樣硬化型所佔比率最大(82.6％),而無血管高信號徵組以小血管病變型為主(56.3％);有血管高信號徵組血管嚴重狹窄及閉塞所佔比率明顯高于無血管高信號徵組(34.9％vs 5.6％,39.5％vs 0.9％),Spearman等級相關分析顯示頸動脈-大腦中動脈血管狹窄程度與血管高信號徵存在正相關關繫(r=0.599,P=0.000).與無血管高信號徵組相比,有血管高信號徵組的梗死體積更大,入院24h內美國國立衛生研究院卒中量錶(NIHSS)評分更高,差異均有統計學意義(P＜0.05).ROC麯線顯示血管高信號徵診斷血管嚴重狹窄的靈敏度為84.38％、特異度為88.52％[麯線下麵積(AUC)=0.892,95％CI:0.85～0.94,P＜0.05],診斷血管閉塞的靈敏度為88.89％、特異度為85.76％(AUC=0.929,95％CI:0.89～0.97,P＜0.05).在大動脈粥樣硬化型急性腦梗死患者(148例)中的狹窄率70％～99％及狹窄率100％亞組中,血管高信號徵評分高者的梗死體積較評分低者更小,神經功能缺損程度較評分低者更輕,差異均有統計學意義(P＜0.05). 結論 FLAIR序列血管高信號徵可以用來評估血管嚴重狹窄或閉塞,且在大動脈粥樣硬化型急性腦梗死患者中,血管嚴重狹窄及閉塞患者的血管高信號徵評分越高,病情程度越輕.
목적 탐토MRI액체쇠감반전회복(FLAIR)서렬혈관고신호정평고급성전순배뇌경사환자적혈관협착정도화병정엄중정도적가행성. 방법 선택자2013년5월지2014년5월련속입주안휘의과대학제삼부속의원신경내과적급성전순배뇌경사환자340례,소유환자균완성상관MRI검사,포괄자공진확산가권성상(DWI)、FLAIR급경부、두로자공진혈관성상(MRA).근거FLAI서렬혈관고신호정출현여부장환자분위무혈관고신호정조화유혈관고신호정조,비교2조적기본림상자료、혈관학지표급병정엄중정도,응용수시자공작특정곡선(ROC)계산혈관고신호정진단혈관엄중협착화폐새적령민도、특이도,분석혈관고신호정대신TOAST분형중대동맥죽양경화형급성뇌경사환자병정엄중정도적평고개치. 결과 340례급성전순배뇌경사환자중유109례(32.1％)존재혈관고신호정.재TOAST분형구성비급혈관협착정도분급방면,무혈관고신호정조화유혈관고신호정조간차이존재통계학의의(P＜0.05),기중유혈관고신호정조이대동맥죽양경화형소점비솔최대(82.6％),이무혈관고신호정조이소혈관병변형위주(56.3％);유혈관고신호정조혈관엄중협착급폐새소점비솔명현고우무혈관고신호정조(34.9％vs 5.6％,39.5％vs 0.9％),Spearman등급상관분석현시경동맥-대뇌중동맥혈관협착정도여혈관고신호정존재정상관관계(r=0.599,P=0.000).여무혈관고신호정조상비,유혈관고신호정조적경사체적경대,입원24h내미국국립위생연구원졸중량표(NIHSS)평분경고,차이균유통계학의의(P＜0.05).ROC곡선현시혈관고신호정진단혈관엄중협착적령민도위84.38％、특이도위88.52％[곡선하면적(AUC)=0.892,95％CI:0.85～0.94,P＜0.05],진단혈관폐새적령민도위88.89％、특이도위85.76％(AUC=0.929,95％CI:0.89～0.97,P＜0.05).재대동맥죽양경화형급성뇌경사환자(148례)중적협착솔70％～99％급협착솔100％아조중,혈관고신호정평분고자적경사체적교평분저자경소,신경공능결손정도교평분저자경경,차이균유통계학의의(P＜0.05). 결론 FLAIR서렬혈관고신호정가이용래평고혈관엄중협착혹폐새,차재대동맥죽양경화형급성뇌경사환자중,혈관엄중협착급폐새환자적혈관고신호정평분월고,병정정도월경.
Objective To evaluate whether MRI fluid attenuated inversion recovery (FLAIR)vascular hyperintensity (FVH) is an effective indicator for severe vascular stenosis or occlusion and disease severities in patients with acute anterior circulation infarction.Methods Three hundred and forty consecutive patients with acute anterior circulation infarction,admitted to our hospital from May 2013 to May 2014,were enrolled as subjects.All subjects were completed brain MR diffusion-weighted imaging (DWI),FLAIR and neck vascular or brain magnetic resonance angiography (MRA).According to the extent of FVH,all subjects were classified into negative FVH and positive FVH groups.Clinical data were obtained and compared among patients with different grades of FVH,and receiver operating characteristic (ROC) curve was used to calculate the sensitivity and specificity of FVH diagnosis of vascular severe stenosis or occlusion.The value of FVH in evaluating the disease severities of patients with large artery atherosclerosis combined with acute cerebral infarction according to new TOAST classification was evaluated.Results FVH was observed in 109 (32.06％) of the 340 patients.Significant differences were noted in the new TOAST classification ratio and vascular stenosis grading between the two groups; in the positive FVH group,the largest ratio was patients with large-artery atherosclerosis (82.6％),while that was patients with small vessel diseases (56.3％); the ratio of patients with severe vascular stenosis and occlusion in positive FVH patients was significantly higher than that in negative FVH patients (34.9％ vs.5.6％,39.5％ vs.0.9％).Spearman rank correlation analysis indicated that the degrees of vascular stenosis of carotid artery-middle cerebral artery were positively correlated to FVH (r=0.599,P=0.000).As compared with the negative FVH group,FVH patients had larger infarct volume and higher initial NIHSS scores (P＜0.05).ROC curve indicated that FVH had a sensitivity of 84.38％ and a specificity of 88.52％ in detecting artery stenosis (area under the curve [AUC]=0.892,95％ CI=0.85-0.94,P＜0.05),and a sensitivity of 88.89％ and a specificity of 85.76％ in detecting the vessel occlusion (AUC=0.929,95％CI:0.89-0.97,P＜0.05).In patients with acute cerebral infarction combined with artery atherosclerosis,patients with high FVH scores showed smaller infarct volumes and slighter neurological symptoms as compared with those with low FVH (P＜0.05).Conclusions FVH predicts vascular severe stenosis or occlusion with high sensitivity and specificity.In severe vascular stenosis or occlusion group,higher FVH scores are associated with lighter strokes.
