磁共振血管成像及灌注加权成像在后循环脑梗死预后评估中的应用

Application of MR angiography and perfusion-weighted imaging in prognosis evaluation of posterior circulation cerebral infarction

目的探讨MRA、DWI和PWI在后循环脑梗死(PCCI)预后评估中的作用。方法选取112例行头颅MRA、DWI及PWI检查的PCCI患者作为研究对象;于发病后30d进行Rankin残障量表(mRS)评分,并根据mRS评分将PCCI患者分为预后不良组和预后良好组,比较2组患者临床资料、影像学参数及半定量影像学评分的差异,运用受试者工作特征曲线(ROC)评估检测指标对预后的预测效能,并分析预后不良的影响因素。结果病情程度不同的PCCI患者间大动脉狭窄率、:rADC、rMTT、rCBV、rCBF、MRI-PC-ASPECTS评分及BACS-MRA评分差异有统计学意义(P<0.05)。单因素分析发现,年龄、高脂血症、病情严重程度、大动脉狭窄率、病变部位、:rADC、rMTT、rTTP、rCBV、rCBF、MRI-PC-ASPECTS评分及BACS-MRA评分与预后不良相关。ROC曲线分析显示,大动脉狭窄率、rADC、rMTT、rTTP、rCBV、rCBF、MRI-PC-ASPECTS评分及BACS-MRA评分预测预后不良的AUC分别为0.676、0.685、0.597、0.631、0.656、0.695、0.655和0.716。多因素Logistic回归显示,病情程度、大动脉狭窄率、rADC、rCBF、MRI-PC-ASPECTS评分及BACS-MRA评分是预后的独立影响因素。结论MRA、DWI和PWI能较好地预测PCCI预后。

Objective To investigate the role of MRA,DWI and PWI in prognosis evaluation of PCCI.Methods 112 patients with PCCI were collected and examined by MRA,DWI and PWI.After thirty days the onset of the disease,the Rankin disability scale(mRS)score was performed.According to the mRS score,PCCI patients were divided into poor prognosis group and good prognosis group.The differences of clinical data,imaging parameters and semi quantitative imaging scores between the two groups were compared.The predictive effect of detection indexes on prognosis was evaluated by receiver operating characteristic curve(ROC),and the influencing factors of poor prognosis were analyzed.Results There were significant differences in the rate of large artery stenosis,rADC,rMTT,rCBV,rCBF,MRI-PC-ASPECTS aspects and BACS-MRA scores among patients with different severity of PCCI(P<0.05).Univariate analysis showed that age,hyperlipidemia,severity of disease,arterial stenosis rate,lesion location,rADC,rMTT,rTTP,rCBV,rCBF,MRI-PC-ASPECTS aspects score and BACS-MRA score were associated with poor prognosis.ROC curve analysis showed that the AUC of large artery stenosis rate,rADC,rMTT,rTTP,rCBV,rCBF,MRI-PC-ASPECTS aspects score and BACS-MRA score were 0.676,0.685,0.597,0.631,0.656,0.695,0.655 and 0.716,respectively.Multivariate logistic regression showed that the severity of disease,the rate of large artery stenosis,rADC,rCBF,MRI-PC-ASPECTS score and BACS-MRA score were independent prognostic factors.Conclusion MRA,DWI and PWI could better predict the prognosis of PCCI.