脑后动脉梗死患者局部缺血性病变程度预测视野缺损改善的临床价值

Clinical value of regional extent of ischemic lesion for the improvement of visual field defects in patients with posterior cerebral artery infarction

目的 研究大脑后动脉(PCA)梗死患者局部缺血性病变程度(rEIL)预测视野缺损(VFD)改善的临床价值。方法 2020年9月—2023年7月,前瞻性纳入PCA缺血性梗死引起的半侧VFD患者38例,上象限VFD 35例,下象限VFD 29例。利用弥散加权成像计算视觉皮层rEIL。将随访3个月时视野评分(VFS)改善20%定义为VFD显著改善。利用Spearman相关性和Logistic回归模型评估预测半侧VFD或上/下象限VFD改善的相关因素。受试者工作特征(ROC)曲线分析对组合不同的变量亚组进行多变量分类测试。结果 22例(57.89%)半侧VFD显著改善,上象限VFD和下象限VFD显著改善率分别为40.00%和44.83%。经Spearman分析,舌回和距状回rIEL(%)与半侧/上象限/下象限ΔVFS均呈负相关,另外楔状回rIEL(%)与半侧ΔVFS也呈负相关(P<0.05)。经单因素和多因素Logistic回归分析,舌回和距状回rEIL(%)可能是半侧VFD或上象限VFD改善较差的独立预测因素(P<0.05)。ROC结果显示,临床变量(年龄+入院时NIHSS+基线VFS+梗死体积)联合舌回和距状回rEIL可提高VFD改善结局的预测效能,曲线下面积由0.767(95%CI:0.618~0.916)增加至0.963(95%CI:0.891~1.000)。结论 基于单独皮层的rEIL可相对准确地预测VFD的改善。将舌回和距状回rEIL数据补充到临床变量中可以提高PCA梗死后VFD预测模型的效能。

Objective To investigate the clinical value of regional extent of ischemic lesion(rEIL)for the improvement of visual field defects in patients with posterior cerebral artery(PCA)infarction.Methods From September 2020 to July 2023,38 hemispheric VFD(hemi-VFD),35 upper quadrant VFD(upper-VFD),and 29 lower quadrant VFD(lower-VFD)caused by PCA infarction were prospectively included.The visual cortex rEIL was calculated using diffusion-weighted imaging.A 20%improvement in visual field score(VFS)at 3-month follow-up was defined as a significant improvement in VFD.Spearman correlation and Logistic regression were used to evaluate the factors predicting improvement in hemispheric VFD or upper/lower quadrant VFD.Receiver Operating characteristic(ROC)curve analysis was performed to test the predictive efficacy of different variable combinations for multivariate classification.Results 22 cases(57.89%)showed significant improvement in hemi-VFD.Significant improvement rates in upper-VFD and lower-VFD were 40.0%and 44.83%,respectively.Spearman analysis showed a negative correlation between rIEL(%)of the lingual gyrus and calcarine gyrus andΔVFS of the hemi/upper/lower-quadrant.The rIEL(%)of the cuneus gyrus was also negatively correlated with theΔVFS of hemi-quadrant(P<0.05).Univariate and multivariate logistic regression analysis suggested that the rEIL(%)of the lingual gyrus and calcarine gyrus are independent predictors of poor improvement in hemi-VFD or upper-VFD(P<0.05).ROC results showed that clinical variables(age+NIHSS at admission+baseline VFS+infarct volume)combined with lingual and calcarine gyrus rEIL could improve the predictive efficacy of VFD improvement outcomes.The area under the curve increased from 0.767(95%CI:0.618-0.916)to 0.963(95%CI:0.891-1.000).Conclusion rEIL based on a single cortex can relatively accurately predict the improvement of VFD.Adding the rEIL of the lingual gyrus and calcarine gyrus to clinical variables can improve the performance of the VFD prediction model after PCA infarction.