FLAIR血管高信号和DWI在缺血性脑卒中的临床价值

The Clinical Value of FLAIR Vascular Hyperintensity and DWI in Ischemic Stroke

目的探讨液体衰减反转恢复血管高信号征-扩散加权成像(FVH-DWI)不匹配和FVH-DWI匹配在大脑中动脉(MCA)狭窄或闭塞所致缺血性卒中的临床意义及预后价值。方法回顾性分析109例MCA狭窄或闭塞所致的缺血性卒中患者资料,依据FVH与DWI的关系分为FVH-DWI不匹配组66例,FVH-DWI匹配组43例。详细记录两组患者的相关临床和影像学基线资料并比较两组数据的差异;逐一采用单因素Logistic回归分析基线资料的变量与FVH-DWI不匹配之间的关系;调整Logistic回归分析中筛选出的相关混杂因素对FVH-DWI不匹配的影响后,进一步利用多元回归分析探讨DWI-ASPECTS评分与FVH-DWI不匹配之间的独立作用。采用受试者工作特征(ROC)曲线分析DWI-ASPECTS评分诊断FVH-DWI不匹配的价值。结果两组患者的年龄、甘油三酯、房颤、发病至MR检查时间、DWI-ASPECTS评分、3个月改良Rankin量表(mRS)评分及预后良好情况(3个月mRS≤2分)等基线资料信息有统计学差异(P<0.05)。多元回归分析显示DWI-ASPECTS评分(OR 4.695,95%CI 2.511~9.247,P<0.001)是FVH-DWI不匹配的独立预测因子。ROC曲线显示DWI-ASPECTS评分为5.5分时,DWI-ASPECTS鉴别FVH-DWI不匹配的诊断价值最高,敏感度为0.879,特异度为0.860,约登指数为0.739。结论缺血卒中患者存在FVH-DWI不匹配预示着较好的预后,当DWI-ASPECTS评分为5.5分时,DWI-ASPECTS鉴别FVH-DWI不匹配的诊断价值最高。

Objective To investigate the clinical significance and prognostic value of FVH-DWI mismatch and FVHDWI match in ischemic stroke caused by middle cerebral artery stenosis or occlusion.Methods Retrospective analysis of109 cases of ischemic stroke caused by middle cerebral artery stenosis or occlusion were divided into 66 cases of FVH-DWI mismatch group and 43 cases of FVH-DWI match group according to the relationship between FVH and DWI.Detailed re-cords of clinical and radiographic baseline characteristics and comparing the differences of data in two groups,univariate logistic regression was used to analyze the relationship between baseline variables and FVH-DWI mismatch.After adjusting the influence of relevant confounding factors selected by logistic regression analysis on FVH-DWI mismatch,multivariate regression analysis was used to explore the independent effect of DWI-ASPECTS score and FVH-DWI mismatch.The value of FVH-DWI mismatch was diagnosed by DWI-ASPECTS score using receiver operating characteristic(ROC)curve anolysis.Results The two groups were significantly different(P<0.05)for the following variables:age,triglycerides,AF,symptom onset to MRI,DWI-ASPECTS,mRS score at 3 months and the number of 3-month mRS≤2.Multiple regression analysis showed that the DWI-ASPECTS score(OR=4.695,95%CI=2.511-9.247,P<0.001)was an independent predictor of FVH-DWI mismatch.DWI-ASPECTS had the highest diagnostic value for identifying FVH-DWI mismatch when the ROC curve showed that the DWI-ASPECTS score was 5.5.The sensitivity was 0.879,the specificity was 0.860,and the Youden index was 0.739.Conclusion FVH-DWI mismatch in patients with ischemic stroke indicates a better prognosis.When the DWI-ASPECTS score was 5.5,DWI-ASPECTS had the highest diagnostic value for identifying FVH-DWI mismatch.