磁共振液体反转恢复序列血管高信号对短暂性脑缺血发作的临床价值

Application of Magnetic Resonance Imaging Fluid- attenuated Inversion Recovery Vascular Hyperintensities in Transient Ischemic Attack

目的：探讨磁共振成像液体反转恢复序列血管高信号（FVH）在短暂性脑缺血发作（TIA）诊断中的临床价值。方法收集2011年5月~2013年7月因TIA住院的连续患者218例的一般临床背景资料，包括性别、年龄、心血管疾病、TIA或脑卒中病史、TIA持续时间等，计算ABCD2评分。全部病例均在症状发作24 h内进行MRI和MRA检查。FVH阳性的患者在初次检查7 d后行MRA和MRI复查。随访90 d。结果45例出现FVH （21%），其中15例伴弥散加权成像（DWI）高信号，均位于FVH同侧。相对于FVH阴性患者，FVH阳性患者中，心房颤动（〈0.001）、DWI阳性（P=0.020）和脑动脉闭塞性病变（AOL）（P=0.003）更多见，并且TIA持续时间较短（P=0.010）。多元Logstic回归分析，心房颤动（OR=7.17,95%CI：2.71~18.4），AOL （OR=4.93,95%CI：3.53~12.6）和偏瘫（OR=2.84,95%CI：1.21~7.42）与FVH独立相关。7 d后复查，30例FVH消失（66%，短暂性FVH）。短暂性FVH阳性病例中，心房颤动发病率更高（P=0.020），而AOL发病率下降（〈0.001）。共随访197例患者（90%），FVH阳性患者中，5例发展为复发性TIA，6例发展为缺血性脑卒中（IS），都出现在FVH同侧；FVH阴性组患者中，2例发展为复发性TIA，5例发展为IS。COX比例风险分析， FVH （HR=3.64,95%CI：1.08~12.6）和AOL （HR=3.82,95%CI：1.07~15.8）与复发性TIA或IS相关。结论 FVH可以对TIA诊断做出一定帮助，并且能够对复发性TIA或IS做出一定的预测。

Objective To investigate the application of magnetic resonance imaging （MRI） fluid-attenuated inversion recovery vascular hyperintensities （FVH） for the diagnosis of transient ischemic attack （TIA）. Methods Consecutive 218 inpatients for TIA from May 2011 to July 2013 were reviewed with gender, age, cardiovascular risk factors, TIA or a history of stroke, TIA duration, and calculate the ABCD2 scores. All patients accepted MRI and MRA within 24 hours of symptom onset. FVH positive patients would follow up MRI and MRA with-in 7 days. All the patients were followed up in 90 days. Results FVH was identified in 45 patients （21%）, 15 cases of them was found diffu-sion weighted imaging （DWI） hyperintensities on the same sides. The prevalence of atrial fibrillation （AF, 〈0.001）, DWI positive （P=0.010） and arterial occlusive lesions （AOL, P=0.003） were more in the FVH positive patients than in the negative ones, while the duration of symptoms was shorter （P=0.010）. Multivariate Logistic regression analysis showed that AF （OR=7.17, 95%CI：2.71-18.4）, AOL （OR=4.93, 95%CI：3.53-12.6） and hemiplegic （OR=2.84, 95%CI：1.21-7.42） independently associated with FVH. 7 days after the onset, FVH was not found in 15 patients （65%, transient FVH）, in whom the prevalence of AF was more （P=0.020）, and AOL was less （〈0.001）. A total of 197 patients （90%） were successfully followed up. In the FVH-positive patients, 5 cases developed into recurrent TIA and 6 into ischemic stroke （IS）, focused on the the same sides of FVH;while the FVH-negative patients, 2 cases developed into recurrent TIA and 5 into IS. COX pro-portional hazard analysis showed that FVH （HR=3.64, 95%CI：1.08-12.6） and AOL （HR=3.82, 95%CI：1.07-15.8） independently associat-ed with the recurrence of TIA or IS. Conclusion FVH can be helpful for the diagnosis of TIA and predictions for recurrent TIA or IS after a TIA.