磁共振血管成像-扩散加权成像不匹配预测基底动脉闭塞型急性后循环脑梗死缺血半暗带的价值

Value of magnetic resonance angiography-diffusion weighted imaging mismatch in predicting ischemic penumbra in acute posterior cerebral infarction with basilar artery occlusion

目的探讨MR血管成像-扩散加权成像不匹配(MDM)预测基底动脉闭塞型急性后循环脑梗死缺血半暗带的价值。方法回顾性连续纳入2015年9月至2018年7月中国医科大学附属第四医院神经内科住院的发病24 h内基底动脉闭塞型急性后循环脑梗死的住院患者58例,将38例扩散加权成像(DWI)-Alberta卒中项目早期CT评分(Alberta stroke program early CT score,ASPECTS)≥7分的患者分为MDM阳性(MDM-P)组,20例DWI-ASPECTS<7分的患者为MDM阴性(MDM-N)组,比较两组患者一般资料、入院美国国立卫生研究院卒中量表(NIHSS)评分及早期神经功能恶化(END,72 h后NIHSS评分增加≥4分)及预后良好[治疗后3个月改良Rankin量表(mRS)评分≤2分]情况。将出现END的21例患者纳入END(+)组,未出现END的37例患者纳入END(-)组,比较两组患者一般资料、入院至治疗时间、再灌注治疗及MDM-P情况,并进行二分类多因素Logistic回归分析探讨MDM-P对END的影响。结果MDM-P组和MDM-N组一般资料差异均无统计学意义(均P>0.05);两组患者在入院NIHSS评分[3(2,12)分比11(4,26)分,Z=-2.434]、DWI-ASEPCTS[8(7,8)分比4(3,5)分,Z=12.950]和END比例[47.4%(18/38)比15.0%(3/20),χ^2=5.944]方面差异均有统计学意义(均P<0.05)。END(+)组和END(-)组一般资料和入院至治疗时间差异均无统计学意义(均P>0.05),再灌注治疗[42.9%(9/21)比67.6%(25/37),χ^2=3.372]和MDM-P[85.7%(18/21)比54.1%(20/37),χ^2=5.944]差异有统计学意义(均P<0.05)。将再灌注治疗和MDM-P纳入二分类多因素Logistic回归分析,发现MDM-P(OR=4.914,95%CI:1.158~20.860,P=0.031)是基底动脉闭塞型急性后循环脑梗死END的独立预测因素。结论MDM-P可以独立预测基底动脉闭塞型急性后循环脑梗死END,提示这类患者可能存在缺血半暗带,为指导再灌注治疗提供依据。

Objective To explore the value of MRA-DWI mismatch(MDM)in predicting ischemic penumbra in acute posterior cerebral infarction with basilar artery occlusion.Methods From September 2015 to July 2018,58 acute posterior cerebral infarction patients with basilar artery occlusion within 24 hours from symptom onset in the Department of Neurology,the Fourth Affiliated Hospital of China Medical University were retrospectively recruited.The thirty-eight patients with DWI-ASPECTS≥7 were divided into the MDM-P group and twenty patients with DWI-ASPECTS<7 were divided into the MDM-N groups.The baseline data,National Institute of Health stroke scale(NIHSS)score at admission,early neurologic deterioration(END,NIHSS score increased≥4 after 72 hours)and favorable functional outcome(mRS score≤2)were compared between the two groups.Simultaneously,21 patients with END were divided into END(+)group and 37 patients without END were divided into END(-)group.The baseline data,onset to treat time(OTT),reperfusion therapy and MRA-DWI mismatch(MDM-P)were also compared between two groups.Subsequently,binary multivariate Logistic regression analysis was carried out to explore the impact of MRA-DWI mismatch on END.Results There was no significant difference in general information between the MDM-P group and the MDM-N group(P>0.05);the differences in NIHSS(3[2,12]vs.11[4,26],Z=2.434)and DWI-ASPECTS(8[7,8]vs.4[3,5],Z=12.950)were statistically significant(all P<0.05).The eighteen(47.4%)patients in the MDM-P group experienced END and three(15.0%)patients in the MDM-N group separately experienced END.The difference was statistically significant(χ^2=5.944,P=0.015).Compared with the END(-)group,the END(+)group showed no significant difference in general information and OTT(P>0.05),but significant difference in reperfusion therapy(42.9%[9/21]vs.67.6%[25/37],χ^2=3.372)and MDM-P(85.7%[18/21]vs.54.1%[20/37],χ^2=5.944)(all P<0.05).Logistic regression analysis showed MRA-DWI mismatch(OR,4.914,95%CI 1.158-20.860,P=0.031)was an independent predictor of early neurological deterioration in acute posterior cerebral infarction.Conclusions MRA-DWI mismatch may be a predictor of END in acute posterior cerebral infarction with basilar artery occlusion,indicating that ischemic penumbra may be present in these patients,and it provides evidence for guiding reperfusion therapy.