短暂性脑缺血发作患者IVIM参数变化及其对预后的评估价值分析

The changes of IVIM parameters in patients with transient ischemic attack and analysis of their prognostic valuation value

目的分析短暂性脑缺血发作(TIA)患者体素内不相干运动(IVIM)参数变化及其对预后的评估价值。方法选取该院2019年1月至2021年5月收治的疑似TIA患者156例进行研究,均进行IVIM检测。根据患者是否为TIA,将患者分为对照组(无TIA患者,n=78)以及研究组(TIA患者,n=78)。观察比较两组患者脑组织IVIM各参数;采用受试者工作特征曲线(ROC曲线)分析IVIM各参数诊断TIA患者的效能。结果研究组快速表观扩散系数(ADC_(fast))、灌注信号比例(f)值显著低于对照组(P<0.05)。两组标准表观扩散系数(ADC_(stand))、慢速表观扩散系数(ADC_(slow))值差异无统计学意义(P>0.05);ROC曲线显示,ADC_(stand)、ADC_(slow)、ADC_(fast)、f值诊断TIA的曲线下面积分别为0.624、0.290、0.981、0.965;其中ADC_(fast)取值为0.692 mm^(2)/s时,诊断TIA的特异度为89.07%,灵敏度为97.68%;f取值为37.40%时,诊断TIA的特异度为95.34%,灵敏度为95.28%。经随访,78例TIA患者中无再发TIA者37例,再发TIA者22例,进展为脑梗死19例。进展为脑梗死患者ADC_(fast)、f值显著低于再发TIA者,再发TIA患者ADC_(fast)、f值显著低于无再发TIA患者(P<0.05);单因素分析显示,患者发病至就诊时间、有TIA史是其预后的影响因素(P<0.05);多因素Logistic回归分析显示,患者发病至就诊时间长、有TIA史、ADC_(fast)、f值较低是患者预后的独立危险因素(P<0.05)。结论TIA患者IVIM主要表现为ADC_(fast)、f值降低,脑组织微循环灌注减弱。IVIM可直观反映患者脑组织弥散信息及病灶部位微循环灌注,对TIA患者脑组织缺血评估及诊断具有一定帮助,同时其参数对患者预后评估也有参考价值。

Objective To analyze the changes of intravoxel incoherent motion(IVIM)parameters in patients with transient ischemic attack(TIA)and their prognostic evaluation value.Methods A total of 156 patients with suspected TIA admitted to our hospital from January 2019 to May 2021 were selected for research,and all of them underwent IVIM detection.According to whether the patients were TIA or not,they were divided into control group(no TIA patients,n=78)and observation group(TIA patients,n=78).The changes of each parameters of IVIM in brain tissue of the two groups of patients was observed and compared.Receiver operating characteristic curve(ROC_(curve))was used to analyze the efficacy of IVIM parameters in predicting the prognosis of TIA patients.Results The ADC_(fast)and f-value in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in ADC_(stand)and ADC_(slow)values between the two groups(P>0.05).ROC_(curve)showed that AUC of ADC_(stand),ADC_(slow),ADC_(fast)and f-value were 0.624,0.290,0.981,0.965,respectively.When ADC_(fast)was 0.692 mm^(2)/s,the specificity was 89.07%and sensitivity was 97.68%.When f-value was 37.40%,the specificity was 95.34%and sensitivity was 95.28%.After follow-up,among the 78 TIA patients,37 had no recurrent TIA,22 had recurrent TIA,and 19 had progressive cerebral infarction.The ADC_(fast)and f-value of patients with cerebral infarction were significantly lower than those with recurrent TIA,and the ADC_(fast)and f-value of patients with recurrent TIA were significantly lower than those without recurrent TIA(P<0.05).Univariate analysis showed that the time from the onset of the patient to the visit and the history of TIA were the influencing factors for the prognosis(P<0.05);Multivariate Logistic regression analysis showed that long time from onset to visit,combined with past TIA history,lower ADC_(fast)and f-value were independent risk factors affecting the prognosis of patients(P<0.05).Conclusion IVIM in patients with TIA mainly manifests as lower ADC_(fast),f-value,and weakened brain tissue microcirculation perfusion.IVIM can directly reflect the diffusion information of the patient′s brain tissue and the microcirculation perfusion of the lesion.It is helpful to the assessment and diagnosis of brain tissue ischemia in patients with TIA.At the same time,its parameters also have reference value for the prognosis evaluation of patients.