液体衰减反转恢复序列脑干白质高信号评估前循环急性缺血性卒中的预后

Brain-Stem White Matter Hyperintensity on Fluid-Attenuated Inversion Recovery Sequence in Evaluating the Prognosis of Anterior Circulation Acute Ischemic Stroke

目的探讨脑干白质高信号(BWMH)评估前循环急性缺血性卒中(AIS)预后的价值。资料与方法回顾性分析159例前循环AIS的临床和常规MRI资料,采用90 d改良Rankin量表(mRS)评分、美国国立卫生研究院卒中量表(NIHSS)评分、Fazekas评分评估预后。分析预后良好与不良病例的临床和常规MRI因素,采用多因素Logistic回归分析确定预后相关的临床和常规影像学指标,采用受试者工作特征(ROC)曲线分析常规MRI模型、临床模型及增加BWMH后的综合模型对预后的评估效能。结果159例患者中,BWMH阳性57例(35.85%)、阴性102例(64.15%);预后良好112例中,BWMH阳性28例(25.0%);预后不良47例中,BWMH阳性29例(61.70%)。与BWMH阴性组比较,BWMH阳性患者年龄较大[67(61,73)岁比56(50,65)岁,Z=-4.361,P<0.001]、入院NIHSS评分[5(3,9)分比3(2,7)分,Z=-2.884,P=0.004]及Fazekas评分[3(3,4)分比2(1,3)分,Z=-5.135,P<0.001]较高。BWMH是预后不良的独立预测因素(OR=4.216,95%CI 1.617~10.997;P=0.003)。临床因素模型与常规MRI模型的ROC曲线下面积分别为0.837、0.759,常规MRI+临床因素+BWMH综合模型的曲线下面积为0.876,敏感度、特异度、约登指数分别为0.85、0.83、0.681。结论BWMH是前循环AIS预后不良有价值的指标,该征象有助于提高临床影像预测前循环AIS预后的效能。

Purpose To explore the value of brain-stem white matter hyperintensity(BWMH)in evaluating the outcome of anterior circulation acute ischemic stroke(AIS).Materials and Methods The clinical and routine MR data of 159 patients with anterior circulation AIS were retrospectively analyzed.The 90-day modified Rankin scale(mRS)score,national institute of health stroke scale(NIHSS)score,and Fazekas score were used to determine the prognosis.Logistic regression analysis was performed to analyze the clinical and conventional MR factors of patients with poor outcome.Receiver operating characteristic curve(ROC)was employed to analyze the prognostic evaluation efficiency of various models,including the conventional MR model,clinical model and the combined model(conventional MR+clinical model+BWMH).Results Among 159 patients with AIS,BWMH was positive in 57 cases(35.85%)and negative in 102 cases(65.15%).Among the 112 cases with good outcome,28 cases(25.0%)were positive BWMH,and 29 cases(61.70%)were positive BWMH in 47 cases with poor outcome.The age of the BWMH positive group was significantly older than that of the BWMH negative group,and the admission NIHSS score and Fazekas score of the BWMH positive group were significantly increased than those of the BWMH negative group.There were all significant differences in age,admission NIHSS score and Fazekas score between BWMH positive and negative group[age:67(61,73)vs.56(50,65)years;Z=-4.361,P<0.001.NIHSS score:5(3,9)vs.3(2,7);Z=-2.884,P=0.004.Fazekas score:3(3,4)vs.2(1,3);Z=-5.135,P<0.001].Logistic regression analysis showed that BWMH(OR=4.216,95%CI 1.617-10.997;P=0.003)was an independent prognostic factor with poor outcome in 90 days.ROC analysis showed that the areas under the curve of conventional MR model and clinical model were 0.759 and 0.837,respectively.However,the AUC of combined model increased to 0.876.The sensitivity,specificity and Youden index of combined model were 0.85,0.83 and 0.681,respectively.Conclusion BWMH is a valuable biological biomarker for poor outcome of anterior circulation AIS.This feature could be helpful to improve the efficacy of clinical imaging model in predicting the prognosis of patients with anterior circulation AIS.