高分辨率磁共振成像增强扫描下大脑中动脉粥样硬化斑块的强化特点对频发前循环短暂性脑缺血发作的预测价值

Predictive Value of the Enhancement Features of Middle Cerebral Artery Atherosclerotic Plaque on High Resolution-MRI Enhanced Scan for the Frequency of Anterior Circulation Transient Ischemic Attacks

目的探讨高分辨率(HR)-磁共振成像(MRI)增强扫描下大脑中动脉(MCA)粥样硬化斑块的强化特点对频发前循环短暂性脑缺血发作(TIA)的预测价值。方法选取2019年12月至2021年3月南阳市中心医院神经内科收治的前循环TIA患者118例为研究对象。收集患者的基线资料,根据患者24 h内TIA发作频率,将其分为频发组(≥2次,56例)和非频发组(<2次,62例)。记录患者斑块位置及血管狭窄程度、斑块强化特点(包括强化等级、强化模式)。采用多因素Logistic回归分析探讨频发前循环TIA的影响因素,并构建斑块强化特点预测频发前循环TIA的模型;采用ROC曲线评估斑块强化特点预测频发前循环TIA的价值。结果频发组高血压、糖尿病发生率高于非频发组,血管狭窄程度重于非频发组(P<0.05)。多因素Logistic回归分析结果显示,强化等级〔OR=3.607,95%CI(1.226,10.612)〕、强化模式〔OR=0.251,95%CI(0.065,0.969)〕是频发前循环TIA的影响因素(P<0.05)。根据多因素Logistic回归分析结果,构建斑块强化特点预测频发前循环TIA风险的模型,为Y=-1.697+1.283X1-1.382X2,其中Y为频发前循环TIA风险、X1为强化等级、X2为强化模式。ROC曲线分析结果显示,该模型预测频发前循环TIA的AUC为0.761〔95%CI(0.649,0.852)〕,最佳截断值为0.44,灵敏度为79.55%,特异度为64.52%。结论HR-MRI增强扫描下MCA粥样硬化斑块的强化特点(强化等级及强化模式)是频发前循环TIA的影响因素,且其对频发前循环TIA有一定预测价值。

Objective To investigate the predictive value of the enhancement features of middle cerebral artery(MCA)atherosclerotic plaque on high resolution(HR)-magnetic resonance imaging(MRI)enhanced scan for the frequency of anterior circulation transient ischemic attacks(TIA).Methods A total of 118 patients with anterior circulation TIA who were admitted to the Department of Neurology,Nanyang Central Hospital from December 2019 to March 2021 were selected as subjects.The baseline data of patients were collected and patients were divided into frequent group(≥2 times,56 cases)and non-frequent group(<2 times,62 cases)based on the frequency of TIA within 24 h.The location of plaque,degree of vascular stenosis and plaque enhancement features(including enhancement grade and enhancement mode)were recorded.Multivariate Logistic regression analysis was used to investigate the influencing factors of the frequency of anterior circulation TIA,and a model was established to predict the frequency of anterior circulation TIA by the of plaque enhancement features.ROC curve was used to evaluate the value of plaque enhancement features in predicting the frequency of anterior circulation TIA.Results The incidence of hypertension and diabetes in the frequent group was higher than that in the non-frequent group,and the degree of vascular stenosis was heavier than that in the non-frequent group(P<0.05).Multivariate Logistic regression analysis results showed that enhancement grade[OR=3.607,95%CI(1.226,10.612)]and enhancement mode[OR=0.251,95%CI(0.065,0.969)]were the influencing factors for the frequency of anterior circulation TIA(P<0.05).According to the results of multivariate Logistic regression analysis,a model was established to predict the frequency risk of anterior circulation TIA by plaque enhancement features,which was Y=-1.697+1.283X1-1.382X2,where Y was the frequency risk of anterior circulation TIA,X1 was the enhancement grade,and X2 was the enhancement mode.ROC curve analysis results showed that the AUC of the model in predicting the frequency of anterior circulation TIA was 0.761[95%CI(0.649,0.852)],the best cut-off value was 0.44,the sensitivity was 79.55%,and the specificity was 64.52%.Conclusion The enhancement features(enhancement grade and enhancement mode)of MCA atherosclerotic plaque on HR-MRI enhanced scan were the influencing factors for the frequency of anterior circulation TIA,and they have certain predictive value for the frequency of anterior circulation TIA.