摘要
目的探究磁共振弥散加权成像(DWI)与灌注加权成像(PWI)评估脑卒中侧支循环的价值。方法回顾性选取2022年3月至2024年1月宣城市人民医院接收的脑卒中患者80例,患者均接受CT血管造影检查,并采用美国介入和治疗神经放射学会(ASITN)分级系统进行侧支循环评分,将ASITN评分≤2分的34例患者纳入侧支循环不丰富组,将ASITN评分≥3分的46例患者纳入侧支循环丰富组。在入组当天详细收集患者临床资料,包括患者的性别、合并症、治疗方法、治疗后颅内出血、年龄、入院美国国立卫生研究院卒中量表(NIHSS)评分、发病至磁共振成像(MRI)检查时间、发病至静脉溶栓时间、发病至动脉取栓时间等;均接受DWI、PWI检查,对患者的侧支循环情况进行评估,记录其影像学检查参数,包括DWI梗死体积、Tmax>6 s体积及Tmax>10 s体积、脑血流量(CBF)、脑血容量(CBV)、对比剂峰值时间(TTP)和对比剂平均通过时间(MTT)。采用受试者操作特征(ROC)曲线评估各项影像学参数对患者侧支循环不丰富的诊断价值。结果侧支循环丰富组、侧支循环不丰富组患者在性别构成比、高血压、糖尿病、高同型半胱氨酸血症、心房颤动、治疗方法、治疗后颅内出血、年龄、入院NIHSS评分、发病至MRI检查时间、发病至静脉溶栓时间、发病至动脉取栓时间方面比较,差异均无统计学意义(P>0.05)。两组的治疗前DWI梗死体积比较,差异无统计学意义(P>0.05);侧支循环不丰富组患者的Tmax>6 s体积、Tmax>10 s体积、低灌注强度比值、TTP、MTT分别为(122.65±17.89)mL、(58.44±12.01)mL、0.44±0.05、(15.88±1.13)s、(6.13±0.54)s,均高于侧支循环丰富组[(91.66±15.45)mL、(26.66±5.45)mL、0.33±0.07、(15.11±1.22)s、(5.88±0.45)s],CBF、CBV分别为(22.66±2.45)mL/(100 g·min)、(1.98±0.22)mL/100 g,均低于侧支循环丰富组[(25.33±2.12)mL/(100 g·min)、(2.44±0.16)mL/100 g],差异均有统计学意义(P<0.05)。ROC曲线分析可知,Tmax>6 s体积、Tmax>10 s体积、低灌注强度比值、CBF、CBV、TTP、MTT对患者侧支循环不丰富具有一定诊断价值,其曲线下面积(AUC)分别为0.923、0.827、0.884、0.798、0.934、0.663、0.651,将上述指标中AUC高于0.750的指标进行联合诊断,其AUC为0.954,高于各指标单独诊断。结论磁共振DWI与PWI在评估脑卒中患者的侧支循环状态中具有显著价值,能够提供重要的临床诊断信息,有助于指导脑卒中的治疗决策和预后评估。
Objective To explore the value of magnetic resonance diffusion weighted imaging(DWI)and perfusion weighted imaging(PWI)to assess the collateral circulation in stroke.Methods Eighty stroke patients who were from Xuancheng People's Hospital from March 2022 to January 2024 were retrospectively selected,all patients underwent CT angiography,and using the American Society for Interventional and Treatment Neuroradiology(ASITN)grading system,34 patients with ASITN score≤2 were included in the poor collateral circulation group,and 46 patients with ASITN score≥3 were included in the rich collateral circulation group.The clinical data of the patients were collected in detail on the day of enrollment,including gender,comorbidities,treatment methods,intracranial hemorrhage after treatment,age,National Institutes of Health Stroke Scale(NIHSS)score at admission,time from onset to magnetic resonance imaging(MRI)examination,time from onset to intravenous thrombolysis,time from onset to arterial thrombectomy,etc.All patients underwent DWI and PWI examinations.The collateral circulation of the patients was evaluated,and the imaging examination parameters were recorded,including DWI infarct volume,Tmax>6 s volume and Tmax>10 s volume,cerebral blood flow(CBF),cerebral blood volume(CBV),time to peak(TTP)and mean transit time(MTT).The diagnostic value of various imaging parameters for patients with insufficient collateral circulation was evaluated using the receiver operating characteristic(ROC)curve.Results There were no statistically significant differences in gender composition ratio,hypertension,diabetes,hyperhomocysteinemia,atrial fibrillation,treatment method,intracranial hemorrhage after treatment,age,NIHSS score on admission,time from onset to MRI examination,time from onset to intravenous thrombolysis,and time from onset to arterial thrombectomy between the rich collateral circulation group and the poor collateral circulation group(P>0.05).There was no statistically significant difference between the two pre-treatment DWI infarct volume groups(P>0.05),The volume of Tmax>6 s,the volume of Tmax>10 s,the ratio of hypoperfusion intensity,TTP and MTT in the patients with insufficient collateral circulation were(122.65±17.89)mL,(58.44±12.01)mL,0.44±0.05,(15.88±1.13)s and(6.13±0.54)s,respectively,which were higher than those in the rich collateral circulation group[(91.66±15.45)mL,(26.66±5.45)mL,0.33±0.07,(15.11±1.22)s,(5.88±0.45)s],CBF and CBV were(22.66±2.45)mL/(100 g·min)and(1.98±0.22)mL/100 g,respectively,which were lower than those in the rich collateral circulation group[(25.33±2.12)mL/(100 g·min),(2.44±0.16)mL/100 g],the differences were statistically significant(P<0.05).According to the ROC curve analysis,Tmax>6 s volume,Tmax>10 s volume,low perfusion intensity ratio,CBF,CBV,TTP,MTT had some diagnostic value for patient collateral circulation,their area under curve(AUC)values were 0.923,0.827,0.884,0.798,0.934,0.663,0.651,respectively,Joint diagnosis of the AUC value above 0.750,its AUC value was 0.954,higher than each index separately diagnosis.Conclusion Magnetic resonance DWI and PWI is of significant value in assessing the collateral circulation status of stroke patients,and can provide important clinical diagnostic information and help to guide treatment decisions and prognosis assessment of stroke.
作者
刘建光
陆志前
丁亮
李刚
武岳
LIU Jian-guang;LU Zhi-Qian;DING Liang(Department of Imaging,Xuancheng People's Hospital,Xuancheng Anhui 242000,China)
出处
《临床和实验医学杂志》
2025年第4期421-425,共5页
Journal of Clinical and Experimental Medicine
基金
安徽省教育厅自然科学重点项目(编号:2022AH051473)。
关键词
CT血管造影
磁共振扩散加权成像
灌注加权成像
美国介入和治疗神经放射学会分级系统
侧支循环
CT angiography
Magnetic resonance diffusion weighted imaging
Perfusion weighted imaging
American Society for Interventional and Treatment Neuroradiology
Collateral circulation
