DWI联合MRA检查在急性期脑梗死患者短期预后评估中的应用价值

Application value of DWI combined with MRA examination in short-term prognosis assessment of patients with acute cerebral infarction

    摘要
  • 摘要:
    目的 探讨弥散加权成像（DWI）联合磁共振血管成像（MRA）检查在急性期脑梗死患者短期预后评估中的价值。
    方法 采用回顾性病例−对照研究，分析2022年3月至2024年11月榆林市星元医院收治的120例急性期脑梗死患者男性66例、女性54例，年龄（58.2±4.8）岁的临床及影像资料。所有患者于溶栓治疗后7 d采用美国国立卫生研究院卒中量表（NIHSS）评估短期预后。根据NIHSS评分将所有患者分为预后不良组（NIHSS评分>15分）和预后良好组（NIHSS评分≤15分）。比较2组患者梗死部位DWI参数表观扩散系数（ADC）、相对表观扩散系数（rADC）和MRA参数（血管狭窄率、侧支循环评分），采用Pearson相关分析、多因素logistic回归分析、受试者工作特征（ROC）曲线评估各指标的相关性及预测价值。计量资料的组间比较采用独立样本t检验。
    结果 预后不良组（n=46）与预后良好组（n=74）间ADC（0.36±0.06）×10−3 mm2/s对（0.45±0.12）×10−3 mm2/s、rADC（62.37±10.38）%对（69.75±10.47）%、侧支循环评分（2.80±0.75）分对（3.54±0.53）分、血管狭窄率（65.82±5.63）%对（59.49±5.40）%的差异均有统计学意义（t=3.766~6.325，均P<0.001）。Pearson相关分析结果显示，ADC、rADC、侧支循环评分与NIHSS评分呈负相关（r=−0.769、−0.698、−0.744，均P<0.05）；血管狭窄率与NIHSS评分呈正相关（r=0.673，P=0.003）。多因素logistic回归分析结果显示，ADC（OR=0.569，95%CI：0.399~0.811）、rADC （OR=0.593，95%CI：0.412~0.853）、侧支循环评分（OR=0.565，95%CI：0.395~0.809）是急性期脑梗死患者短期预后的独立保护因素（均P<0.05）；血管狭窄率（OR=1.542，95%CI：1.116~2.131，P<0.05）是急性期脑梗死患者短期预后的独立危险因素。ROC曲线分析结果显示，DWI联合MRA检查评估急性期脑梗死患者短期预后的曲线下面积为0.934（95%CI：0.888~0.980）、特异度为94.59%，灵敏度为80.43%。
    结论 DWI联合MRA检查对急性期脑梗死患者短期预后具有较高的预测价值，可为临床诊治提供客观依据。

     

    Abstract:
    Objective To explore the value of diffusion-weighted imaging (DWI) combined with magnetic resonance angiography (MRA) examination in the evaluation of short-term prognosis in patients with acute cerebral infarction.
    Methods This study was a retrospective case-control study. The clinical and imaging data of 120 patients (66 males and 54 females with an average age of (58.2±4.8) years) with acute cerebral infarction admitted to Yulin Xingyuan Hospital from March 2022 to November 2024 were selected. The short-term prognosis of all patients was evaluated using the National Institutes of Health stroke scale (NIHSS) 7 days after thrombolytic therapy. In accordance with the NIHSS score, all patients were divided into the poor prognosis group (NIHSS score>15) and the good prognosis group (NIHSS score≤15). The DWI parameters (apparent diffusion coefficient (ADC) and relative apparent diffusion coefficient (rADC)) and MRA parameters (vascular stenosis rate and collateral circulation score) at the infarction site were compared between the two groups. Pearson correlation analysis, multivariate logistic regression analysis, and receiver operating characteristic (ROC) curve were used to evaluate the correlation and predictive value of these parameters. Independent sample t-test was used for comparison of measurement data between groups.
    Results Statistically significant differences were found in ADC ((0.36±0.06)×10−3 mm2/s vs. (0.45±0.12)×10−3 mm2/s), rADC ( (62.37±10.38)% vs. (69.75±10.47)% ), collateral circulation score ((2.80±0.75) score vs. (3.54±0.53) score), and vascular stenosis rate ( (65.82±5.63)% vs. (59.49±5.40)% ) between the poor prognosis group (n=46) and the good prognosis group (n=74; t=3.766–6.325, all P<0.001). Pearson correlation analysis results showed that ADC, rADC, and collateral circulation score were negatively correlated with NIHSS score (r=−0.769, −0.698, −0.744; all P<0.05), and vascular stenosis rate was positively correlated with NIHSS score (r=0.673, P=0.003). Multivariate logistic regression analysis results showed that ADC (OR=0.569, 95%CI: 0.399–0.811), rADC (OR=0.593, 95%CI: 0.412–0.853), and collateral circulation score (OR=0.565, 95%CI: 0.395–0.809) were independent protective factors for short-term prognosis of patients with acute cerebral infarction (all P<0.05). Vascular stenosis rate (OR=1.542, 95%CI: 1.116–2.131, P<0.05) was an independent risk factor for short-term prognosis of patients with acute cerebral infarction. ROC curve analysis results showed that the area under the curve of DWI combined with MRA examination in evaluating the short-term prognosis of patients with acute cerebral infarction was 0.934 (95%CI: 0.888–0.980), with a specificity of 94.59% and a sensitivity of 80.43%.
    Conclusion DWI combined with MRA examination has high predictive value for the short-term prognosis of patients with acute cerebral infarction, it can provide an objective basis for clinical diagnosis and treatment.

     

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