基于MRI和临床特征的列线图预测急性缺血性脑卒中近期功能预后

MRI and clinical features-based nomogram for predicting short-term brain functional prognosis in acuteischemic stroke

目的:探讨基于MRI和临床特征的列线图对前循环急性缺血性脑卒中(AIS)患者近期功能预后的预测价值。方法:回顾性分析2018年1月-2020年12月在本院确诊且符合本研究要求的160例前循环AIS患者的临床和影像资料。根据随访资料,基于发病后90天改良Rankin量表(mRS)评分,将患者分为预后良好组(60例,mRS≤2)和预后不良组(53例,mRS>2)。由两位影像科医师采用双盲法评估脑梗死区域的MRI表现,包括边界、是否伴出血、出血面积比、梗死区体积、DWI上信号均匀性、ADC值等,并记录临床基线特征(包括血压、血糖、吸烟史、脑卒中史、心房颤动史、NIHSS基线和mRS_(基线)评分)。采用多元logistic回归分析建立包含影像学特征和临床特征的临床-影像列线图。采用受试者工作特征曲线(ROC)下面积(AUC)评价列线图的预测效能,采用拟合优度检验(Hosmer-Lemeshow)评价列线图的校准度,并采用决策曲线分析评估列线图的临床实用价值。结果:多因素回归分析结果显示DWI上信号不均匀、边缘模糊、梗死区体积、平均ADC值、mRS_(基线)评分及房颤是前循环AIS患者90天功能预后的独立预测因素(优势比分别为3.54、1.80、4.13、0.46、3.16和2.03)。临床-影像列线图在训练集和验证集中预测预后不良的AUC分别为0.94(95%CI:0.90~0.98)和0.92(95%CI:0.83~1.00)。在训练集和验证集中列线图均具有良好的校准度(P=0.36、0.25)。当阈值概率为0.10~0.98时,列线图的净收益水平较高。结论:临床-影像列线图对前循环AIS患者近期功能预后具有良好的预测价值,可为临床决策提供一定的帮助。

Objective:To investigate the value of MRI and clinical features-based nomogram for predicting short-term brain functional outcomes in patients with acute ischemic stroke(AIS).Methods:The clinical and imaging data of 160 patients with anterior circulation AIS diagnosed and met the requirements of this study in our hospital from January 2018 to December 2020 were retrospectively analyzed.Based on the modified Rankin scale(mRS)90days after AIS,the patients were divided into good prognosis group(mRS score≤2)and poor prognosis group(mRS score>2).The baseline clinical data(blood pressure,blood glucose,cigarette smoking,stroke history,atrial fibrillation history,admission NIHSS score,admission mRS score)and MRI features of infarction areas including margin,he-morrhage,ratio of bleeding area,infarct volume,signal heterogeneity on DWI and ADC value were evaluated by two radiologists with double-blind method.The imaging and clinical features were combined to establish a clinical-image nomogram using multiple logistic regression method.Area under receiver operating characteristic curve(ROC)and Hosmer-Lemeshow test were used to evaluate the predictive efficiency and calibration of nomogram,respectively.Decision curve analysis(DCA)was used to evaluate the clinical usefulness of the nomogram.Results:The results of multivariate regression analysis showed that MRI features including blurred edge,infarction volume,signal heterogeneous on DWI and average ADC value,and baseline clinical findings including mRS score and atrial fibrillation were independent predictors of function prognosis 90 days after AIS in patients with anterior circulation AIS(OR=3.54,1.80,4.13,0.46,3.16 and 2.03,respectively).The AUC of clinical-image nomogram was 0.94(95%CI:0.90~0.98)in the training cohort and 0.92(95%CI:0.83~1.00)in the validation cohort.The good calibration was confirmed in the training and validation cohort(P=0.36 and 0.25).When the threshold probability was about 0.10 to 0.98,nomogram′s net benefit level was significantly higher.Conclusion:Clinical-imaging nomogram shows good performance for prediction of short-term brain functional outcome of patients with anterior circulation AIS,and can provide certain help for clinical decision-making.