大血管闭塞性脑卒中亚急性期磁敏感血管征的表现

Susceptibility vessel sign in subacute stroke patients with large vessel occlusion

目的:探讨不同病因所致的大血管闭塞性脑卒中患者在亚急性期磁敏感血管征(susceptibility vessel sign,SVS)的表现。方法:选择北京大学第一医院神经内科病房2017年12月—2019年8月收治的经磁共振血管成像、CT血管造影或数字减影血管造影证实存在颅内大血管闭塞,且在发病第3~14天接受磁敏感加权成像(susceptibility-weighted imaging,SWI)检查的卒中患者进行回顾性分析,对比心源性栓塞(cardioembolism,CE)和大动脉粥样硬化性卒中(large artery atherosclerosis,LAA)患者的SVS征出现情况。结果:共有51例患者进入分析,其中女19例、男32例,平均年龄(63.04±11.23)岁。两组患者在性别、高血压、糖尿病、冠心病、高脂血症、吸烟、入院美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分间差异均无统计学意义。与LAA组相比,CE组患者年龄更大,合并房颤的比例更高,差异有统计学意义(P<0.05)。共有30例患者表现为SVS征阳性,心源性栓塞组患者SVS征阳性率为30%,显著低于大动脉粥样硬化性卒中患者(65.9%),两组间差异有统计学意义(P=0.039)。在敏感度测试中仅纳入SWI检查时间在卒中后第7~14天的患者,两组间SVS征阳性率的差异仍有统计学意义(0 vs.72.7%,P=0.006)。以有无房颤分组,合并房颤的卒中患者SVS征阳性率为25%,显著低于无房颤的卒中患者(65.1%),两组间差异有统计学意义(P=0.043)。结论:大动脉闭塞性脑卒中发病的亚急性期,心源性栓塞患者的SVS征阳性率低于LAA亚型的卒中患者;SVS征在卒中不同亚型鉴别中的作用尚需要进一步大样本的病例研究来验证。

Objective:To investigate the presentation of susceptibility vessel sign(SVS)in subacute stroke patients with large vessel occlusion.Methods:We collected consecutive stroke patients who were admitted to Peking University First Hospital from December 2017 to August 2019 retrospectively.Those who had intracranial large vessel occlusion and received sensitivity weighted imaging(SWI)within 3 to 14 days after stroke onset were included in our analysis.The diagnosis of large vessel occlusion was based on magnetic resonance angiography(MRA),CT angiography(CTA)or digital subtraction angiography(DSA).The demographic information,clinical characteristics and imaging results were obtained from medical record.The occurrence rates of SVS sign were compared between stroke patients with cardioembolism(CE)and large artery atherosclerosis(LAA).In the sensitivity analysis,we performed a subgroup analysis in those patients who received SWI within 7 to 14 days after stroke onset.We also compared the occurrence rate of SVS sign between the patients with and without atrial fibrillation.Results:A total of 51 patients,19 females and 32 males,with an average age of(63.04±11.23)years were analyzed in this study.Compared with LAA group,the patients in CE group were older and more likely to have an atrial fibrillation(P<0.05).There were no significant differences between the CE group and LAA group in gender,hypertension,diabetes,coronary heart disease,hyperlipidemia,smoking,or National Institute of Health stroke scale(NIHSS)score at admission.SVS sign was found in 30 patients.Of whom,3 were in CE group and 27 in LAA group.The occurrence rate of SVS sign was higher in the LAA group than in the CE group significantly(65.9%vs.30.0%,P=0.039).The subgroup analysis showed that,in the patients who received SWI examination within 7 to 14 days after stroke onset,the differences between the two groups were still statistically significant(0 vs.72.7%,P=0.006).Another sensitivity analysis showed that,the rate of SVS in the patients with atrial fibrillation was significantly lower than those patients without atrial fibrillation(25%vs.65.1%,P=0.043).Conclusion:In subacute stroke patients,the occurrence rate of SVS sign in CE group was lower than that of LAA group.The significance of SVS sign in the differentiation of stroke subtype needs further validation.