MRI-FLAIR序列高信号血管征对急性脑梗死的应用价值研究

Value of MRI-FLAIR hyperintense vessel sign in the acute cerebral infarction

目的探讨MRI-FLAIR序列高信号血管征(HVS)对急性脑梗死的应用价值。方法选取急性脑梗死住院患者100例为研究对象,所有患者均行常规颅脑MRI扫描(包括FLAIR序列)及3D-TOF MRA扫描(时间飞跃MRA,以获取脑血管狭窄相关信息)。采用Spearmen相关分析HVS与责任动脉狭窄程度的关系,比较有无HVS患者的脑梗死面积、早期神经功能恢复及预后情况。采用logistic回归分析HVS阳性的影响因素。结果100例急性脑梗死患者中,轻中度狭窄62例,重度狭窄闭塞38例,HVS阳性35例,HVS阴性65例。其中重度狭窄闭塞组HVS阳性为86.84%,明显高于轻中度狭窄组的3.23%,差异有统计学意义(χ^(2)=76.37,P<0.05);Spearman分析显示,HVS与血管狭窄不同程度呈正相关(r=0.84,P<0.05);HVS阳性组ASPECT评分、美国国立卫生研究院卒中量表(NIHSS)评分的差值、30 d Rankin评分与HVS阴性组比较,差异均无统计学意义(t分别=1.26、1.64、0.69,P均>0.05);logis⁃tic回归分析显示,发病时间<3 d,血流流速<11.3 cm/s和合并糖尿病是HVS阳性的主要影响因素(OR分别=28.23、9.68、3.48,P均<0.05)。结论HVS阳性与脑梗死相关血管狭窄的严重程度有较高的一致性,可能是脑梗死加重的预测指标,提示临床应该尽快完善相关脑血管检查并尽早干预治疗,以改善患者预后。

Objective To explore the value of MRI-FLAIR hyperintense vessel sign(HVS)in acute cerebral infarction. Methods A total of 100 hospitalized patients with acute cerebral infarction were selected as the research subjects.All patients underwent conventional craniocerebral MRI(including FLAIR sequence)and 3D-TOF MRA(time-hopping MRA to obtain information related to cerebrovascular stenosis).Spearmen correlation analysis was used to analyze the relationship between HVS and the degree of responsible artery stenosis,and to compare the cerebral infarction area,early neurological function recovery and prognosis of patients with or without HVS.Logistic regression was used to analyze the influencing factors of positive HVS. Results Among the 100 patients with acute cerebral infarction,there were 62 cases of mild and moderate stenosis,38 cases of severe stenosis occlusion,35 cases of HVS positive and 65 cases of HVS negative.The positive rate of HVS in severe stenosis occlusion group was 86.84%,which was significantly higher than that in mild and moderate stenosis group 3.23%(χ^(2)==76.37,P<0.05).Spearman analysis showed that HVS was positively correlated with different degree of vascular stenosis(r=0.84,P<0.05). There were no significant differences in ASPECT score,NIHSS score,30 d Rankin score between HVS positive group and HVS negative group(t=1.26,1.64,0.69,P>0.05).Logistic regression analysis showed that onset time <3 days,blood flow rate <11.3 cm/s and diabetes mellitus were the main influencing factors for HVS positivity(OR =28.23,9.68,3.48,P<0.05). Conclusion The positive HVS sign has a high consistency with the severity of cerebral infarct related vascular stenosis,which may be a predictor of cerebral infarction aggravation,suggesting that clinical improvement of related cerebrovascular examination and early intervention treatment should be made as soon as possible to improve the prognosis of patients.