治疗后DWI-ASPECTS评分对急性缺血性脑卒中的预后评估

Prognostic Value of ASPECTS on Post-Treatment Diffusion Weighted Imaging for Acute Ischemic Stroke Patients after Endovascular Thrombectomy

目的探讨Alberta卒中项目早期CT评分(ASPECTS)对急性缺血性脑卒中(AIS)患者血管内血栓切除术(EVT)后扩散加权成像(DWI)的预后评估价值。方法选择淮安市第一人民医院神经内科2019年3月至2022年2月接受EVT的大脑中动脉AIS患者121例,根据患者3个月后改良Rankin量表(mRS)评分分为预后良好组(0~2分)和预后不良组(3~6分)。比较两组患者临床资料和影像指标差异,应用Logistic回归分析临床及影像指标中有统计学意义的变量,使用受试者工作特征曲线(ROC)和DeLong检验比较治疗后DWI-ASPECTS评分和梗死体积对AIS患者的预后评估价值。结果共121例患者,预后良好组67例(55.4%),出血转化17例(25.4%);预后不良组54例(44.6%),出血转化30例(55.5%)。预后良好组DWI-ASPECTS评分更高、梗死体积更小、入院美国国立卫生研究院卒中量表(NIHSS)评分更低,与预后不良组差异有统计学意义(P<0.05)。治疗后DWI-ASPECTS评分和梗死体积有相关性,差异有统计学意义(r=-0.832,P=0.00)。Logistic回归分析显示治疗后DWI-ASPECTS评分(OR=0.315,P=0.00)及梗死体积(OR=1.068,P=0.00)均是大脑中动脉AIS患者EVT术后预后不良的独立预测因子。经ROC曲线进一步分析显示EVT术后DWI-ASPECTS评分评估3个月后mRS评分的曲线下面积(AUC)为0.887(95%CI:0.827~0.948),预测不良预后的最佳临界点为5.5分,敏感度为73.1%,特异度为87%。而梗死体积评估3个月后mRS评分的AUC为0.907(95%CI:0.854~0.960),预测不良预后的最佳临界点为86.5 ml,敏感度为68.5%,特异度为98.5%。结论治疗后DWI-ASPECTS评分可代替梗死体积来预测AIS患者EVT术后的临床预后。

Objective To assess the value of Alberta Stroke Program Early CT Score(ASPECTS)on post-treatment diffusion weighted imaging for acute ischemic stroke of the middle cerebral artery after endovascular thrombectomy,and compare it with that of infarction volume.Methods A total of 121 patients with acute ischemic stroke of the middle cerebral artery after endovascular thrombectomy from March 2019 to February 2022 were enrolled from the Department of Neurology,Huai'an First Hospital Affiliated to Nanjing Medical University.According to the modified Rankin Scale(mRS)at 3 months,the patients were divided into 2 groups:the favorable outcome group(mRS of 0-2)and the unfavorable outcome group(mRS of 3-6).The clinical datas and imaging indicators were compared between the two groups.Logistic regression was used to analyze the above statistically significant variables and the prognostic value of post-treatment DWI-ASPECTS and infarction volume were assessed and compared using receiver-operating-characteristic curves and the DeLong method.Results Out of 121 patients,there were 67 patients in the favorable outcome group with bleeding transformation occurred in 17 cases(25.4%)and 54 patients in the unfavorable outcome group with bleeding transformation occurred in 30 cases(55.5%).The DWI-ASPECTS of the good outcome group were higher,the infarction volume was lower and the NIHSS score at admission was lower,which was statistically significant compared with the unfavorable outcome group(P<0.05).Logistic regression analysis showed that NIHSS score at admission(OR=1.111,P=0.048),DWI-ASPECTS score(OR=0.315,P=0.00)and infarction volume(OR=1.068,P=0.00)were independent predictors of unfavorable outcome after endovascular thrombectomy in both two models.ROC analysis showed that the area under the ROC curve of DWI-ASPECTS was 0.887(95%CI:0.827-0.948),and the cutoff value of post-treatment DWI ASPECTS score for predicting unfavorable outcome was set at 5.5 with the sensitivity was 73.1%and the specificity was 87%,which was comparable with that of infarction volume with the AUC was 0.907(95%CI:0.854-0.960),the cut-off volume was 86.5 ml,the sensitivity 68.5%and the specificity 98.5%.Conclusion Post-treatment DWI-ASPECTS might be a potential surrogate of infarction volume for predicting functional outcome in patients with acute ischemic stroke of the middle cerebral artery after endovascular thrombectomy.