磁共振灌注成像定量参数对老年缺血性脑卒中合并认知功能障碍患者脑卒中复发的预测价值

The predictive value of quantitative parameters of magnetic resonance perfusion imaging for stroke recurrence inelderly patients with ischemic stroke and cognitive dysfunction

目的:探究磁共振灌注成像(PWI)定量参数对老年缺血性脑卒中合并认知功能障碍患者脑卒中复发的预测价值。方法:回顾性分析南阳市中心医院收治的老年缺血性脑卒中患者54例为研究对象,其中男31例,女23例。入院后均进行PWI检查,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)。出院时患者均进行蒙特利尔评估量表(MoCA)进行评分,依据评分结果分为认知功能障碍组(n=19)与非认知功能障碍组(n=35)。所有患者随访6个月,记录复发情况。比较两组rCBF、rCBV、rMTT、rTTP、MoCA评分数值的变化及相关性,探究PWI定量参数对老年缺血性脑卒中合并认知功能障碍患者6个月脑卒中复发的预测评估价值。结果:入组患者6个月后随访,复发脑梗死12例,未复发41例,失访1例。认知功能障碍组患者rCBF与rCBV明显低于非认知功能障碍组,rMTT、rTTPV高于非认知功能障碍组(P<0.001)。Spearman相关性分析显示,MoCA评分与rCBF、rCBV成正相关,与rMTT、rTTP成负相关(P<0.001);ROC曲线分析rCBF、rCBV、rMTT、rTTP对6个月内脑卒中复发有一定的预测价值,rCBF预测价值最高,曲线下面积(AUC)为0.783(95%CI:0.619~0.946,P=0.003)。结论:PWI定量参数对老年缺血性脑卒中合并认知功能障碍患者6个月内卒中复发有较高的预测价值。

Objective To investigate the value of quantitative parameters of magnetic resonance perfusion imaging(PWI)in predicting stroke recurrence in elderly patients with ischemic stroke complicated with cognitive impairment.Method A retrospective analysis was performed on 54 elderly patients with ischemic stroke,including 31 males and 23 females.Cerebral magnetic resonance perfusion imaging(PWI)was performed after admission,including relative cerebral blood flow(rCBF),relative cerebral blood volume(rCBV),relative mean time to transit(rMTT),and relative time to peak(rTTP).All patients were scored on the Montreal Assessment Scale(MoCA)at discharge.According to the scoring results,they were divided into cognitive dysfunction group(19 cases)and non-cognitive dysfunction group(35 cases).All patients were followed up for 6 months and recurrence was recorded.The changes and correlations of rCBF,rCBV,rMTT,rTTP and MoCA scores between the cognitive dysfunction group and the non-cognitive dysfunction group were compared.To explore the value of quantitative parameters of magnetic resonance perfusion imaging in predicting 6-month stroke recurrence in elderly patients with ischemic stroke complicated with cognitive dysfunction.Results After 6 months of follow-up,12 cases of recurrent cerebral infarction,41 cases without recurrence,and 1 case lost to follow-up.rCBF and rCBV in cognitive dysfunction group were significantly lower than those in non-cognitive dysfunction group;rMTT and rTTPV were higher than those in the non-cognitive dysfunction group(P<0.001).Spearman correlation analysis showed that MoCA score was positively correlated with rCBF and rCBV,and negatively correlated with rMTT and rTTP(P<0.001).ROC curve analysis showed that rCBF,rCBV,rMTT and rTTP had certain predictive value for stroke recurrence within 6 months,and rCBF had the highest predictive value and the area under curve was 0.783(95%CI:0.619~0.946 P=0.003).Conclusion PWI quantitative parameters have high predictive value for stroke recurrence within 6 months in elderly patients with ischemic stroke complicated with cognitive dysfunction.