扩散加权成像体积在评估大动脉闭塞缺血性卒中患者灌注成像/扩散加权成像不匹配中的应用价值

DWI Volume in Evaluating Diffusion/Perfusion Mismatch of Artery Occlusion Ischemic Stroke

目的 回顾性分析颈内动脉或大脑中动脉缺血性卒中患者的影像资料及临床资料,以期发现可评估灌注成像（PWI）/扩散加权成像（DWI）不匹配的因素.方法 选择在神经内科住院的颈内动脉或大脑中动脉缺血性卒中患者49例,行头颅DWI及PWI检查后,记录其临床及影像资料.根据检查结果将病人分为PWI/DWI不匹配组及PWI/DWI匹配组,对两组病人的临床及影像资料进行统计学分析.结果 （1）共筛选49例颈内动脉或大脑中动脉缺血性卒中患者,其中PWI/DWI不匹配患者为31例（63.27％）,PWI/DWI匹配患者18例（36.73％）.PWI/DWI不匹配组ASPECTS评分（6.90±1.40）及FVH评分（4.87±3.11）均高于PWI/DWI匹配组（5.44±2.36;3.06±2.71）,且差异有统计学意义（P=0.025;P=0.045）;PWI/DWI不匹配组DWI体积（18.06±19.69）cm3明显小于PWI/DWI匹配组（93.21±102.27）cm3,差异有统计学意义（P=0.006）.（2）ROC分析结果显示ASPECTS评分预测PWI/DWI不匹配的最佳临界值为5.5,敏感度为83.90％,特异度为50.00％;FVH评分预测PWI/DWI不匹配的最佳临界值为5.5,敏感度为51.60％,特异度为88.90％;DWI体积预测PWI/DWI不匹配的最佳临界值为46.87 cm3,敏感度为61.10％,特异度为93.55％.进一步的逻辑回归分析显示DWI体积（OR：1.04;95％CI：1.009～1.072;P=0.029）是PWI/DWI不匹配的独立预测因素,而ASPECTS评分（OR：0.793;95％CI：0.594～1.059;P=0.116）及FVH评分（OR：1.668;95％CI：0.969～2.870;P=0.065）对PWI/DWI不匹配无预测作用.结论 DWI体积与PWI/DWI不匹配具有密切关系,对于因各种原因无法做灌注扫描的颈内动脉或大脑中动脉缺血性卒中病人,可根据DWI体积大致判断是否存在PWI/DWI不匹配,从而做出合适的临床治疗及准确的评估预后.

Objective To analyze retrospectively the clinical data and image data of patients with internal carotid artery or middle cerebral artery ischemic stroke to find the factor for evaluating PWI/DWI mismatch. Methods 49 patients admitted to neurology department with internal carotid artery or middle cerebral artery ischemic stroke were enrolled. After DWI and PWI, the clinical data and image data were recorded. The patients were divided into PWI/DWI mismatch group and PWI/DWI match group, then statistical analysis was carried out. Results （1）A total of 49 cases were recruited in this study, of which 31 patients （63.27%） presented PWI/DWI mismatch while 18 patients （36.73%） presented PWI/DWI match. The ASPECTS score （6.90±1.40） and FVH score （4.87±3.11） in PWI/DWI mismatch group were higher than those in PWI/DWI match group （5.44±2.36;3.06±2.71）, and has statistically difference （P=0.025; P=0.045）; the DWI volume （18.06±19.69） cm3 in PWI/DWI mismatch group was less than that in PWI/DWI match group （93.21±102.27） cm3, and the difference was statistically significant （P=0.006）. （2）ROC analysis showed that the cutoff point of ASPECTS score for predicting PWI/DWI mismatch was set at 5.50 with the sensitivity 83.90% and the specificity 50.00%; the cutoff point of FVH score for predicting PWI/DWI mismatch was set at 5.5 with the sensitivity 51.60% and the specificity 88.90%; the cutoff point of DWI volume for predicting PWI/DWI mismatch was set at 46.87 cm3 with the sensitivity 61.10% and the specificity 93.55%. Further logistic regression analysis showed that DWI volume （OR： 1.04; 95% CI： 1.009～1.072; P=0.029） predicted PWI/DWI mismatch independently, while ASPECTS score （OR： 0.793; 95% CI： 0.594～1.059; P=0.116） and FVH score （OR： 1.668; 95% CI： 0.969～2.870; P=0.065） cannot predicted PWI/DWI mismatch independently. Conclusion DWI volume and PWI/DWI mismatch has close relations. For the internal carotid artery or middle cerebral artery ischemic stroke patients cannot do perfusion scan due to various reasons, DWI volume can roughly judge whether there is PWI/DWI mismatch, thus make the appropriate clinical treatment and accurate prognosis assessment.