Fluid-attenuated inversion recovery （FLAIR） vascular hyperintensity （FVH） is used to assess leptomeningeal collateral circulation, but clinical outcomes of patients with FVH can be very different. The aim of the p...Fluid-attenuated inversion recovery （FLAIR） vascular hyperintensity （FVH） is used to assess leptomeningeal collateral circulation, but clinical outcomes of patients with FVH can be very different. The aim of the present study was to assess a FVH score and explore its relationship with clinical outcomes. Patients with acute ischemic stroke due to middle cerebral artery M1 occlusion underwent magnetic resonance imaging and were followed up at 10 days （National Institutes of Health Stroke Scale） and 90 days （modified Rankin Scale） to determine short-term clinical outcomes. Effective collateral circulation indirectly improved recovery of neurological function and short-term clinical outcome by extending the size of the pial penumbra and reducing infarct lesions. FVH score showed no correlation with 90-day functional clinical outcome and was not sufficient as an independent predictor of short-term clinical outcome.展开更多
目的以灌注成像为参照,探讨MRI液体衰减反转恢复序列血管高信号征(FVH)与弥散加权成像(DWI)不匹配征象在急性前循环大血管闭塞性缺血性卒中血管内取栓术(EVT)前评估中的作用。方法回顾性分析2020年5月至2021年10月就诊于天津市环湖医院...目的以灌注成像为参照,探讨MRI液体衰减反转恢复序列血管高信号征(FVH)与弥散加权成像(DWI)不匹配征象在急性前循环大血管闭塞性缺血性卒中血管内取栓术(EVT)前评估中的作用。方法回顾性分析2020年5月至2021年10月就诊于天津市环湖医院神经外科、发病时间为6~24 h的急性前循环大血管闭塞性缺血性卒中患者的临床资料,共91例。患者均同时接受MRI平扫和灌注成像(CT灌注成像或MRI灌注加权成像)检查,分别应用两种影像筛选模式判断EVT指征。其中MRI平扫判断有EVT指征的标准为存在FVH-DWI不匹配;灌注成像判断EVT指征的标准为梗死核心体积与缺血半暗带不匹配。评价两种影像筛选模式判断EVT指征的一致性,以及经两种方法筛选后行EVT患者术后90 d预后良好[改良Rankin量表评分(mRS)≤2分]率的差异。结果91例患者中,应用FVH-DWI不匹配筛选73例(80.2%)存在EVT指征,其中49例行EVT,术后90 d 28例(57.1%)预后良好。应用灌注成像不匹配筛选75例(82.4%)存在EVT指征,其中55例行EVT,术后90 d 28例(50.9%)预后良好。70例患者同时存在FVH-DWI不匹配和灌注不匹配,13例FVH-DWI和灌注不匹配均不存在,5例存在灌注不匹配而无FVH-DWI不匹配,3例存在FVH-DWI不匹配而无灌注不匹配。根据FVH-DWI不匹配确定EVT指征与根据灌注不匹配确定EVT指征的差异无统计学意义(P=0.724),一致性较好(κ=0.71,95%CI:0.52~0.90);术后90 d预后良好率差异无统计学意义(P=0.660)。同时存在FVH-DWI不匹配和灌注不匹配者术后预后良好占比最高,FVH-DWI不匹配和灌注不匹配均不存在者术后预后良好占比最低。结论MRI平扫FVH-DWI不匹配征象是急性前循环大血管闭塞缺血性卒中患者术前判断EVT指征简单且较为可靠的方法。展开更多
基金supported by the National Natural Science Foundation of China,No.81371521
文摘Fluid-attenuated inversion recovery （FLAIR） vascular hyperintensity （FVH） is used to assess leptomeningeal collateral circulation, but clinical outcomes of patients with FVH can be very different. The aim of the present study was to assess a FVH score and explore its relationship with clinical outcomes. Patients with acute ischemic stroke due to middle cerebral artery M1 occlusion underwent magnetic resonance imaging and were followed up at 10 days （National Institutes of Health Stroke Scale） and 90 days （modified Rankin Scale） to determine short-term clinical outcomes. Effective collateral circulation indirectly improved recovery of neurological function and short-term clinical outcome by extending the size of the pial penumbra and reducing infarct lesions. FVH score showed no correlation with 90-day functional clinical outcome and was not sufficient as an independent predictor of short-term clinical outcome.
文摘目的以灌注成像为参照,探讨MRI液体衰减反转恢复序列血管高信号征(FVH)与弥散加权成像(DWI)不匹配征象在急性前循环大血管闭塞性缺血性卒中血管内取栓术(EVT)前评估中的作用。方法回顾性分析2020年5月至2021年10月就诊于天津市环湖医院神经外科、发病时间为6~24 h的急性前循环大血管闭塞性缺血性卒中患者的临床资料,共91例。患者均同时接受MRI平扫和灌注成像(CT灌注成像或MRI灌注加权成像)检查,分别应用两种影像筛选模式判断EVT指征。其中MRI平扫判断有EVT指征的标准为存在FVH-DWI不匹配;灌注成像判断EVT指征的标准为梗死核心体积与缺血半暗带不匹配。评价两种影像筛选模式判断EVT指征的一致性,以及经两种方法筛选后行EVT患者术后90 d预后良好[改良Rankin量表评分(mRS)≤2分]率的差异。结果91例患者中,应用FVH-DWI不匹配筛选73例(80.2%)存在EVT指征,其中49例行EVT,术后90 d 28例(57.1%)预后良好。应用灌注成像不匹配筛选75例(82.4%)存在EVT指征,其中55例行EVT,术后90 d 28例(50.9%)预后良好。70例患者同时存在FVH-DWI不匹配和灌注不匹配,13例FVH-DWI和灌注不匹配均不存在,5例存在灌注不匹配而无FVH-DWI不匹配,3例存在FVH-DWI不匹配而无灌注不匹配。根据FVH-DWI不匹配确定EVT指征与根据灌注不匹配确定EVT指征的差异无统计学意义(P=0.724),一致性较好(κ=0.71,95%CI:0.52~0.90);术后90 d预后良好率差异无统计学意义(P=0.660)。同时存在FVH-DWI不匹配和灌注不匹配者术后预后良好占比最高,FVH-DWI不匹配和灌注不匹配均不存在者术后预后良好占比最低。结论MRI平扫FVH-DWI不匹配征象是急性前循环大血管闭塞缺血性卒中患者术前判断EVT指征简单且较为可靠的方法。
