DWI联合MRI斑块参数对老年急性脑梗死rt-PA溶栓治疗预后的预测价值

Prognostic value of diffusion-weighted imaging quantitative parameters combined with MRI plaque parameters for rt-PA thrombolytic therapy in elderly patients with acute cerebral infarction

目的探讨磁共振扩散加权成像(DWI)联合磁共振成像(MRI)斑块参数对老年急性脑梗死(ACI)重组组织型纤溶酶原激活剂(rt-PA)溶栓治疗预后的预测价值。方法前瞻性选取2021年1月至2024年1月义马煤业集团股份有限公司总医院收治179例行rt-PA溶栓治疗的老年ACI患者作为研究对象,根据治疗90 d后改良Rankin量表(mRS)评分分为预后良好组和预后不良组。比较两组患者的一般资料、DWI定量参数[表观扩散系数(ADC)]及MRI斑块参数(纤维帽厚度、脂核面积、斑块面积、脂核/斑块面积),采用Logistic回归分析老年ACI患者rt-PA溶栓预后的影响因素,采用受试者工作特征(ROC)曲线分析DWI定量参数联合MRI斑块参数对rt-PA溶栓预后不良的预测价值。结果随访90 d,179例患者共1例脱落,178例患者中预后良好143例,预后不良35例;预后良好组和预后不良组患者的吸烟史[21.68%vs 40.00%]、饮酒史[24.48%vs 45.71%]和治疗前美国国立卫生院卒中量表(NIHSS)评分[(12.49±1.05)分vs(13.27±1.14)分]比较差异均有统计学意义(P<0.05);预后不良组患者的ADC、纤维帽厚度值分别为(0.71±0.22)10^(-3)mm^(2)/s、(0.64±0.19)mm,明显小于预后良好组的(0.96±0.25)10^(-3)mm^(2)/s、(1.02±0.33)mm,脂核面积、斑块面积、脂核/斑块面积值分别为(4.61±1.29)mm^(2)、(9.54±1.31)mm^(2)、(48.32±15.43)%,明显大于预后良好组的(2.49±0.78)mm^(2)、(8.15±1.02)mm^(2)、(30.55±9.76)%,差异均有统计学意义(P<0.05);Logistic回归分析结果显示,矫正其他因素后,ADC、纤维帽厚度、脂核面积、斑块面积、脂核/斑块面积仍是老年ACI患者预后不良的独立影响因素(P<0.05);ROC曲线分析结果显示,ADC、纤维帽厚度、脂核面积、斑块面积、脂核/斑块面积联合预测老年ACI患者rt-PA溶栓后预后不良的曲线下面积(AUC)为0.912,约登指数为0.767,优于各指标单独检测效能。结论DWI、MRI斑块参数与老年ACI rt-PA溶栓治疗预后独立相关,联合应用对预后不良具有较高预测价值,可作为临床预测预后的有效方案,并可为临床防治工作提供理论依据。

Objective To explore the predictive value of diffusion-weighted imaging(DWI)combined with magnetic resonance imaging(MRI)plaque parameters for the prognosis of recombinant tissue-type plasminogen activator(rt-PA)thrombolytic therapy in elderly patients with acute cerebral infarction(ACI).Methods A prospective study was conducted to select 179 elderly patients with ACI who underwent rt-PA thrombolysis treatment at the General Hospital of Yima Coal Industry Group Co.,Ltd.from January 2021 to January 2024.The patients were divided into a good prognosis group and a poor prognosis group based on the modified Rankin scale(mRS)score after 90 days of treatment.The general information,DWI quantitative parameters(apparent diffusion coefficient,ADC),and MRI plaque parameters(fibrous cap thickness,lipid core area,plaque area,lipid core/plaque area)of the two groups of patients were compared.Logistic regression analysis was used to analyze the factors affecting the prognosis of rt-PA thrombolysis in elderly ACI patients,and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of DWI quantitative parameters combined with MRI plaque parameters for poor prognosis of rt-PA thrombolysis.Results During the 90-day follow-up,179 patients were followed up and 1 patient dropped out.Among the 178 patients,143 had a good prognosis and 35 had a poor prognosis.There were significant differences in the smoking history,drinking history,and National Institutes of Health Stroke Scale(NIHSS)score before treatment between the good prognosis group and the poor prognosis group(P<0.05):21.68%vs 40.00%,24.48%vs 45.71%,and(12.49±1.05)points vs(13.27±1.14)points.The ADC and fibrous cap thickness values in the poor prognosis group were(0.71±0.22)10^(-3) mm^(2)/s and(0.64±0.19)mm,respectively,which were significantly lower than(0.96±0.25)10^(-3) mm^(2)/s and(1.02±0.33)mm in the good prognosis group;the values of lipid core area,plaque area,and lipid core/plaque area were(4.61±1.29)mm^(2),(9.54±1.31)mm^(2),and(48.32±15.43)%,respectively,which were significantly larger than(2.49±0.78)mm^(2),(8.15±1.02)mm^(2),and(30.55±9.76)%in the good prognosis group;the differences were statistically significant(P<0.05).The results of logistic regression analysis showed that after correcting for other factors,ADC,fibrous cap thickness,lipid core area,plaque area,and lipid core/plaque area were still independent factors affecting poor prognosis in elderly patients with ACI(P<0.05).ROC analysis results showed that the area under the curve(AUC)of ADC,fibrous cap thickness,lipid core area,plaque area,and lipid core/plaque area in combination to predict poor prognosis after rt-PA thrombolysis in elderly ACI patients was 0.912,with a Youden index of 0.767,which was superior to the performance of each indicator alone.Conclusion The plaque parameters of DWI and MRI are independently correlated with the prognosis of ACI rt-PA thrombolytic therapy in elderly patients,and the combined application of the parameters has high predictive value for poor prognosis,which can be used as an effective scheme for clinical prediction of prognosis and can provide a theoretical basis for clinical prevention and treatment.