FLAIR与SWI对急性缺血性脑卒中患者侧支循环及临床疗效的评估价值

The value of FLAIR and SWI in evaluating collateral circulation and clinical efficacy in patients with acute ischemic stroke

目的探索液体衰减反转恢复序列(FLAIR)与磁敏感加权成像(SWI)在急性缺血性脑卒中(AIS)患者临床疗效评估中的价值。方法本研究为回顾性研究。按照纳入与排除标准,搜集2017年3月—2022年12月于南通市第一人民医院收治的131例AIS患者。根据SWI上多发低信号血管征(MHVs)和FLAIR序列上血管高信号征(FVHs)的显示程度进行分级。按照患者入院时、入院后3 d美国国立卫生研究院卒中量表(NIHSS)评分,把患者分为早期神经功能减退(END)组(NIHSS增加≥2分)71例、非END组(NIHSS增加<2分)60例;按照90 d改良Rankin量表评分(mRS),把患者分为预后良好组(mRS 0~2分)76例、预后不良组(mRS>2分)55例。采用Mann-Whitney U检验比较组间患者的MHVs、FVHs分级差异;Spearman相关系数用于分析MHVs分级与FVHs分级的相关性。结果131例患者中,FVHs分级(0~2级依次为12、72、47例)与MHVs分级(0~3级依次为63、18、28、22例)呈轻度正相关(r=0.390,P<0.001);END组中FVHs、MHVs分级均明显高于非END组,差异均有统计学意义(Z值分别为-3.499、-4.663,P均<0.001);预后不良组MHVs分级明显高于预后良好组,差异有统计学意义(Z=-3.993,P<0.001),两组FVHs分级差异无统计学意义(Z=-1.472,P=0.141)。结论MHVs、FVHs能间接反映AIS患者脑血流动力改变,对缺乏再灌注治疗的超窗AIS患者END发生和90 d预后具有较好的预测价值。

Objective To explore the value of fluid-attenuated inversion recovery(FLAIR)and susceptibility-weighted imaging(SWI)in evaluating the clinical efficacy in patients with acute ischemic stroke(AIS).Methods This was a retrospectively study.According to inclusion and exclusion criteria,131 AIS patients admitted to the first People's Hospital of NanTong from March 2017 to December 2022 were collected.The degree of multiple hypointense vessels(MHVs)on SWI and the degree of vascular hyperintensity(FVHs)on FLAIR were graded.According to the national institutes of Health Stroke Scale(NIHSS)score at admission and 3 days after admission,patients were divided into an early neurological deterioration(END)group(NIHSS increased≥2 points)with 71 cases,and a non-END group(NIHSS increased<2 points)with 60 cases.According to the modified Rankin Scale(mRS)score at 90-days,patients were divided into a good prognosis group(mRS 0-2 points)with 76 cases,and a poor prognosis group(mRS>2 points)with 55 cases.Mann-Whitney U test was used to compare the differences in MHVs grading and FVHs grading between the two groups.Spearman correlation coefficient was used to analyze the correlation between MHVs and FVHs grading.Results Among 131 patients,FVHs grading(0-2 grades with 12,72,and 47 cases,respectively)and MHVs grading(0-3 grades with 63,18,28,and 22 cases,respectively)showed a mild positive correlation(r=0.390,P<0.001);the FVHs and MHVs grading in the END group were significantly higher than those in the non-END group,with statistically significant differences(Z=−3.499 and−4.663,P<0.001,respectively);MHVs grading in the poor prognosis group was significantly higher than that in the good prognosis group,with statistically significant difference(Z=−3.993,P<0.001),but there was no statistically significant difference in FVHs grading between the two groups(Z=−1.472,P=0.141).Conclusions MHVs and FVHs can indirectly reflect hemodynamic changes in AIS patients and have good predictive value for END occurrence and 90-day poor prognosis in AIS patients who lack reperfusion therapy beyond the therapeutic window.