磁敏感加权成像多发低信号血管征与急性脑梗死早期临床预后的研究

Association of Multiple Hypointense Vessels Sign on Susceptibility-Weighted Imaging with Early Neurological Outcome After Acute Cerebral Infarction

目的探讨磁敏感加权成像(SWI)上不对称的明显多发低信号血管征(MHVs)与急性脑梗死后早期临床神经功能预后及相关因素之间的关系。方法回顾性分析本院86例急性脑梗死患者的影像及临床资料,采用半定量的Alberta卒中项目早期CT评分(ASPECTS)系统对所有患者病变血管侧大脑中动脉供血区SWI的MHVs区域进行分级,并与患者入院DWI上梗死灶体积及入院、出院时的NIHSS评分进行相关性分析。结果 86例急性脑梗死患者在SWI图像上病灶内明显的不对称MHVs分级:0级13例,Ⅰ级12例,Ⅱ级15,Ⅲ级46例。MHVs分级与脑血管病的的危险因素无统计学意义(P>0.05);不对称明显的MHVs患者DWI上梗死灶体积更小(P=0.000),入院NIHSS评分较低(P=0.000),相应的出院NIHSS评分也低(P=0.000);MHVs分级与DWI上梗死灶体积、入院及治疗后出院NIHSS呈负相关(r分别为-0.664、-0.447、-0.598,P<0.01)。结论 SWI不对称MHVs能够间接反映梗死区周围侧支循环代偿储备状态,可作为急性脑梗死缺血半暗带的替代标记物,为临床评估病情现状、治疗方案的选择及近期预后的判断提供依据。

Objective To assess the association between the presence of asymmetrically prominent multiple hypointense vessels sign(MHVs) using Susceptibility-weighted Magnetic Resonance Imaging(SWI)and neurologic outcome in patients after acute cerebral infarction. Methods This retrospective cohort study examined 86 patients after ACI admitted to the Second Affiliated Hospital of Shandong First Medical University between 2017 and 2019 who underwent MRI with SWI.We divided the MCA territory into eight areas and modified the ASPECTS system for reference to grade the degree of asymmetrically prominent MHVs.The correlation between the MHVs grade and DWI volume of infarct and NIHSS score was analyzed. Results According to the exclusion criteria, a total of 86 patients with acute cerebral infarction in MCA territory were included.There were 13 patients in MHVs grade 0,12 in MHV grade Ⅰ,15 in MHVs gradeⅡ,and 46 in MHVs grade Ⅲ.There was no statistical significance between MHVs grade and risk factors of cerebrovascular disease(P> 0.05).Patients with asymmetrically prominent MHVs had smaller infarction volume on DWI(P=0.000),lower admission NIHSS score(P=0.000),and lower discharge NIHSS score(P=0.000).MHVs grade was negatively correlated with infarction volume on DWI,NIHSS in admission and discharge after treatment(r=-0.664,r=-0.447,r=-0.598,respectively, P<0.01). Conclusion Asymmetric MHVs on SWI can indirectly reflect the compensatory reserve state of collateral circulation around the infarct area, and can be used as a substitute marker of ischemic penumbra in acute cerebral infarction, and provide the basis for clinical evaluation of patient’s condition, the selection of treatment options and the determination of short-term prognosis.