急性缺血性脑卒中FLAIR血管高信号征的相关因素及预后分析

Analysis of related factors and prognosis of FLAIR vascular hyperintensity sign in acute ischemic stroke

目的探讨大脑中动脉(middle cerebral artery,MCA)供血区急性缺血性脑卒中(acute ischemic stroke,AIS)患者液体衰减反转恢复(fluid attenuated inversion recovery,FLAIR)序列血管高信号征(vascular hyperintensity,FVH)出现的相关因素及与临床预后的关系。材料与方法回顾性分析276例(2016年9月至2019年3月)MCA区域AIS患者的临床及影像资料。分为FVH阳性组和阴性组,阳性组又依据FVH的分布情况分为3个级别。此外,阳性组血管狭窄程度3级的22例患者7 d后复查(根据MRA表现分为血管再通组和未再通组),并进行了90 d随访改良Rankin量表(modified Rankin Scale,mRS)评估(根据90 d mRS评分分为预后良好组(mRS≤2)和不良组(mRS>2)。采用χ^2检验和Fisher精确检验分析影响FVH出现及级别的因素。血管再通组和未再通组之间FVH消失的情况及预后良好组和不良组的基线FVH级别、治疗后FVH消失、血管再通情况采用Fisher精确检验。预后良好组和不良组基线NIHSS评分采用t检验。结果FVH阳性组和阴性组两组之间患者年龄、性别、卒中危险因素及Willis环类型差异无统计学意义。出现症状-MRI检查时间、血管狭窄部位、程度及梗死面积差异具有统计学意义(P值分别为0.011、0.011、0.000、0.000)。阳性组不同级别间仅梗死面积差异具有统计学意义(χ^2=7.026,P=0.030)。复查血管再通组和未再通组之间FVH的消失情况差异具有统计学意义(P=0.000)。预后良好组和不良组之间基线NIHSS评分及治疗后FVH消失情况差异有统计学意义(P=0.000,P=0.002),基线FVH级别及治疗后血管再通情况差异无统计学意义(P=0.290,P=0.080)。结论患者症状-MRI检查时间、血管狭窄部位及程度、梗死面积是影响FVH出现的重要因素。治疗后FVH的消失可以预测闭塞血管再通,且患者预后与基线NIHSS评分、治疗后FVH消失情况有关,基线NIHSS评分低、治疗后FVH消失提示预后良好。

Objective:To investigate related factors of fluid attenuated inversion recovery vascular hyperintensity(FVH)in patients with acute ischemic stroke(AIS)in middle cerebral artery(MCA),and whether FVH associated with stroke outcome.Materials and Methods:Retrospectively analyzed the clinical and imaging datas of 276 patients with MCA territory AIS(from September 2016 to March 2019).The patients were divided into FVH positive group and negative group.FVH positive group was divided into 3 grades according to the distribution of FVH.In addition,after treatment,22 patients with grade 3 vascular stenosis in the FVH-positive group completed followup MR examination at7 days after stroke onset,and completed modified Rankin Scale(mRS)evaluation at 90 days.According to the follow up MRA appearance,patients were divided into two groups:vascular recanalization group and non-vascular recanalization group.According to the mRS at 90 days,patients were divided into two groups:good outcome group(mRS≤2)and poor outcome group(mRS>2).Theχ^2 test and Fisher’s exact test were used to analyze clinical and imaging factors affecting the appear and grade of FVH.Fisher’s exact test was used to analyze the disappearance of FVH between the vascular recanalization group and non-vascular recanalization group,as well as the baselineFVH level,the disappearance of FVH and the vascular recanalization after treatment between the good and poor outcome group.The t-test was used to analyze the difference in baseline NIHSS score between the good and poor outcome group.Results:There were no significant differences in age,gender,stroke risk factors and Willis circle classification among the FVH positive and negative groups.The occurrence of FVH was related to the onset-MR examination time,vascular stenosis location,degree and infarct size(P=0.011,P=0.011,P=0.000,P=0.000).The difference between FVH grades and infarct size was statistically significant(χ^2=7.026,P=0.030).Among the 22 patients,the difference was statistically significant in the disappearance of FVH between the vascular recanalization and non-recanalization group(P=0.000).There were significant differences in baseline NIHSS scores and disappearance of FVH after treatment between the good and poor outcome group(P=0.000,P=0.002),no significant differences in baseline FVH level and vascular recanalization after treatment between the two groups(P=0.290,P=0.080).Conclusions:The patients onset-MR examination time,the location and degree of the vascular stenosis were the important factors that affected the occurrence of FVH,and the disappearance of FVH after treatment could be used to predict the recanalization of the occlusive vascular.The patient’s outcome is related to the baseline NIHSS score and disappearance of FVH after treatment,low baseline NIHSS score and disappearance of FVH after treatment suggest a good outcome.