MR血管成像血流动力学预测椎-基底动脉交界处裂隙型开窗患者发生后循环脑梗死

MR angiography hemodynamics for predicting posterior circulation cerebral infarction at vertebra-basilar artery junction in slit-type fenestrations patients

目的评估基于MR血管成像(MRA)血流动力学预测椎-基底动脉交界处裂隙型开窗患者发生后循环脑梗死的价值。方法随机收集40例经头部MRA诊断的椎-基底动脉交界处裂隙型开窗患者,将其中20例伴后循环脑梗死归为脑梗死组,20例无脑梗死者纳入对照组。基于MRA建立椎-基底动脉模型,以开窗汇合处为A位,开窗左侧血管支为B位,开窗右侧血管支为C位,开窗起点处为D位,分别测量血流动力学参数,包括血流速度(V)、梯度振荡数(GON)、振荡剪应指数(OSI)、壁面压力(WP)、壁面切应力(WSS)及动脉瘤形成指数(AFI)。采用单因素及二元logistic逐步回归分析筛选椎-基底动脉交界处裂隙型开窗患者发生后循环脑梗死的血流动力学参数相关独立危险因素,并以之建立回归模型;绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估单一独立危险因素及回归模型预测椎-基底动脉交界处裂隙型开窗患者发生后循环脑梗死的效能。结果脑梗死组V(A)、V(B)及WSS(D)均高于对照组(P均<0.05),且三者均为椎-基底动脉交界处裂隙型开窗患者发生后循环脑梗死的独立危险因素。以V(A)、V(B)及WSS(D)预测椎-基底动脉交界处裂隙型开窗患者发生后循环脑梗死的AUC为0.78、0.81及0.87,回归模型预测AUC为0.96,并可对92.50%患者做出正确分类。结论MRA血流动力学能有效预测椎-基底动脉交界处裂隙型开窗患者发生后循环脑梗死。

Objective To explore the value of hemodynamics based on MR angiography(MRA)for predicting posterior circulation cerebral infarction at the vertebra-basilar artery junction in patients with slit-type fenestrations.Methods A total of 40 patients with slit-type fenestrations at the vertebra-basilar artery junction diagnosed with head MRA were randomly enrolled,including 20 cases with posterior circulation cerebral infarction(cerebral infarction group)and 20 cases without cerebral infarction(control group).A vertebra-basilar artery model was established based on MRA.Taken the confluence of the fenestration as position A,the left vascular branch of the fenestration as position B,the right vascular branch of the fenestration as position C and the beginning of the fenestration as position D,the hemodynamic parameters,including blood flow velocity(V),gradient oscillation number(GON),oscillatory shear index(OSI),wall pressure(WP),wall shear stress(WSS)and aneurysm formation index(AFI)were measured,respectively.The independent risk factors for posterior circulation cerebral infarction at the vertebra-basilar artery junction in patients with slit-type fenestration were screened using univariate and binary logistic stepwise regression analysis,then a regression model was established.Receiver operating characteristic(ROC)curves were drawn,and the area under the curve(AUC)were calculated to assess the efficacy of each independent risk factor and regression model for predicting posterior circulation cerebral infarction at the vertebra-basilar artery junction in patients with slit-type fenestration.Results V(A),V(B)and WSS(D)in cerebral infarction group were higher than those in control group(all P<0.05),which were all independent risk factors for posterior circulation cerebral infarction at the vertebra-basilar artery junction in patients with slit-type fenestration.AUC of V(A),V(B)and WSS(D)for predicting posterior circulation cerebral infarction in patients with slit-type fenestration at the vertebra-basilar artery junction was 0.78,0.81 and 0.87,respectively,and of the regression model was 0.96,which could correctly classify 92.50%cases.Conclusion MRA Hemodynamics could effectively predict posterior circulation cerebral infarction at the vertebra-basilar artery junction in patients with slit-type fenestration.