磁共振灌注成像定量参数对老年大面积脑梗死患者预后的预测价值

Prognostic value of quantitative parameters of magnetic resonance PWI in elderly patients with massive cerebral infarction

目的探讨磁共振灌注成像(perfusionweightedimaging,PWI)对老年大面积脑梗死患者预后的预测价值。方法回顾性收集2018年1月至2019年1月苏州大学附属第一医院神经内科收治的老年大面积脑梗死患者175例,根据3年内PWI随访结果分为再发脑梗死组78例和对照组97例。比较2组PWI定量参数和其他临床特征差异,各参数包括相对脑血流量(rCBF),相对脑血容量(rCBV),相对平均通过时间(rMTT),相对达峰时间(rTTP)。分析PWI定量参数对大面积脑梗死后再发脑梗死的预测价值。结果与对照组比较,再发脑梗死组rCBF和rCBV明显降低(0.93±0.22vs1.26±0.22,P=0.000;0.94±0.17vs1.11±0.18,P=0.000),rMTT和rTTP明显增高(1.24±0.14vs1.10±0.13,P=0.000;1.27±0.15vs1.12±0.16,P=0.000)。老年大面积脑梗死患者美国国立卫生研究院卒中量表(NIHSS)评分与rCBV呈负相关,与rMTT、rTTP呈正相关(P<0.05)。rCBF、rCBV、rMTT、rTTP和NIHSS评分对老年大面积脑梗死患者3年内再发脑梗死均有较高的预测价值,其中rCBF预测价值最高,曲线下面积为0.841(95%CI:0.784~0.897,P=0.000)。结论PWI定量参数对老年大面积脑梗死患者再发脑梗死具有一定预测价值。

Objective To investigate the prognostic value of quantitative parameters of perfusion weighted imaging(PWI)in elderly patients with massive cerebral infarction.Methods Clinical data of 175 elderly patients with massive cerebral infarction admitted to Department of Neurology of First Affiliated Hospital of Soochow University from January 2018 to January 2019 were collected and analyzed retrospectively.According to recurrent cerebral infarction or not by PWI within 3 years of follow-up,they were divided into recurrent cerebral infarction group(n=78)and control group(n=97).The quantitative parameters of PWI[including relative cerebral blood flow(rCBF),relative cerebral blood volume(rCBV),relative mean transit time(rMTT),and relative time to peak(rTTP)]and other clinical features were compared between the two groups.The predictive values of these quantitative parameters for recurrent cerebral infarction after massive cerebral infarction were analyzed.Results The rCBF(0.93±0.22 vs 1.26±0.22,P=0.000)and rCBV(0.94±0.17 vs 1.11±0.18,P=0.000)was significantly lower,while rMTT(1.24±0.14 vs 1.10±0.13,P=0.000)and rTTP(1.27±0.15 vs 1.12±0.16,P=0.000)were obviously higher in the recurrent cerebral infarction group than the control group.NIHSS score was negatively correlated with rCBV,and positively with rMTT and rTTP in the elderly patients with massive cerebral infarction(P<0.05).rRCBF,rCBV,rMTT,rTTP and NIHSS score had higher predictive values in predicting recurrent cerebral infarction within 3 years after massive cerebral infarction.Among them,rCBF showed the highest predictive performance,with an AUC value of 0.841(95%CI:0.784-0.897,P=0.000).Conclusion Quantitative parameters of PWI have certain predictive values for recurrent cerebral infarction in elderly patients with large area cerebral infar-ction.