改良SWI-ASPECTS预测急性缺血性脑卒中早期神经功能恶化的可行性

Feasibility of modified SWI-ASPECTS in predicting early neurological deterioration in patients with acute ischemic stroke

目的:探讨磁敏感加权成像(SWI)上突出血管征(PVS)预测颅内大动脉重度狭窄或闭塞的急性缺血性脑卒中(AIS)患者早期神经功能恶化(END)的可行性。方法:回顾性分析单侧大脑中动脉(MCA)M1段和/或颈内动脉(ICA)重度狭窄或闭塞AIS患者的临床和影像资料,采用改良Alberta卒中项目早期CT评分(ASPECTS)对SWI上PVS进行评分。根据是否发生END分为END(+)组和END(-)组,比较两组变量,将单因素分析中P<0.1的变量纳入二分类Logistic回归分析。采用受试者工作特征(ROC)曲线评估改良SWI-ASPECTS对END的诊断效能。结果:共纳入76例患者(男63例,女13例),其中24例(31.58%)发生END。单因素分析结果显示,END(+)组患者的改良SWI-ASPECTS、基线NIHSS评分高于END(-)组(P<0.05)。二分类Logistic回归分析结果显示,改良SWI-ASPECTS是END发生的独立危险因素(OR=1.316,95%CI=1.026~1.687,P=0.030)。ROC曲线分析结果显示改良SWI-ASPECTS以6为截点时,曲线下面积为0.733,诊断敏感度为79.20%,特异度为61.50%。结论:改良SWI-ASPECTS可能是预测颅内大动脉重度狭窄或闭塞AIS患者发生END的神经影像学指标;改良SWI-ASPECTS增加侧脑室旁深髓静脉评分,有助于提高深部脑白质区梗死预后的评估效能。

Objective:To explore the feasibility of prominent vessel sign(PVS)on susceptibility weighted imaging(SWI)in predicting early neurological deterioration(END)in acute ischemic stroke(AIS)patients with severe intracranial large arterial stenosis or occlusion.Methods:Clinical and imaging data of AIS patients with severe stenosis or occlusion of unilateral M1 segment of middle cerebral artery(MCA)and/or internal carotid artery(ICA)were retrospectively analyzed.The PVS on SWI was assessed using the modified Alberta stroke programme early CT score(ASPECTS).All patients were divided into END(+)and END(-)groups depending on whether END occurred.The variables were compared between two groups.After univariate analysis,those variables with P<0.1 were subsequently enrolled and analyzed by binary Logistic regressions.The diagnostic efficacy of modified SWI-ASPECTS on END was evaluated by receiver operating characteristic(ROC)curve.Results:Seventy-six patients(63 males and 13 females)were included in the study,and 24 patients(31.58%)presented with END.Univariate analysis showed that patients of END(+)group had higher modified SWI-ASPECTS and admission NIHSS scores(P<0.05).Binary Logistic regressions showed that modified SWI-ASPECTS(OR=1.316,95%CI=1.026~1.687,P=0.030)could independently predict END in AIS patients.ROC curve analysis showed the area under the curve,sensitivity,and specificity was 0.733,79.20%,and 61.50%respectively when the cut-off point was 6 in modified SWI-ASPECTS.Conclusion:The modified SWI-ASPECTS may be an useful neuroimaging biomarker that can help to predict END in AIS patients with severe intracranial large arterial stenosis or occlusion.Combination of the modified SWI-ASPECTS and deep medullary veins score could be helpful to improve the prognostic evaluation of deep white matter infarction.