European Radiology:对于大血管闭塞引起的缺血性卒中患者来说,这一FLAIR征象你一定要知道!

2022-08-17 shaosai MedSci原创

研究确定,FLAIR血管超高信号(FVH)代表了脑外膜侧支循环的缓慢血流,可以预测接受EVT治疗的AIS患者的临床预后。

临床上由大血管闭塞(LVO)引起的急性缺血性卒中(AIS)患者出现早期大面积梗死(即初始Alberta Stroke Program早期CT评分低[ASPECTS≤5])是否应该采用血管内血栓切除术(EVT)是目前急性卒中治疗中最相关的未解之谜。ASPECTS低的患者发生症状性脑内出血(sICH)的风险较高,可挽救的组织比例较小,这也解释了该亚组功能预后为何总体较差

有研究表明侧支循环有助于延长缺血半暗带的维持时间。低的ASPECTS通常与不良的血管连接相吻合。然而,在这一病人群体中,仍有高达30%的病人有良好的侧支循环。因此,在考虑对有大面积梗死核心的卒中患者进行EVT时,侧支循环状况对预后有重要影响。研究确定,FLAIR血管超高信号(FVH)代表了脑外膜侧支循环的缓慢血流,可以预测接受EVT治疗的AIS患者的临床预后

近日,发表在European Radiology杂志的在接受EVT治疗的基线卒中病变较大的AIS患者中评估了侧支循环状态对患者预后的影响,为早期干预的实施提供了重要的参考。

本研究分析了前循环大血管闭塞导致的急性缺血性卒中且ASPECTS≤5的连续患者。由两位独立的神经放射学家使用FVH-ASPECTS评分系统(评分范围从0[无FVH]到7[FVH与所有ASPECTS皮质区域相邻])对侧支循环进行量化。3个月后,使用修改后的Rankin量表(mRS)评分为0至3分定义为良好的功能结局,同时使用多变量回归分析确定FVH评分与临床预后之间的关系。 

共有139名2012年3月-2017年12月期间入院的患者(年龄,63.1±20.8岁;男性,51.8%)被纳入研究。65名(46.8%)患者功能疗效良好(mRS 0-3),43名(30.9%)患者功能独立(mRS 0-2),33名(23.7%)患者在90天内死亡。FVH评分的中位数是4(IQR,3-5)。FVH评分与良好预后独立相关(调整后的OR=1.41[95%CI,1.03-1.92];每增加1分,p=0.03)。 


图 FVH-ASPECTS示例。FVHs被定义为蛛网膜下腔的局灶性、管状或蛇形增生,在至少2个连续的层面上具有典型的动脉走向。FVH评分在2个标准化的层面上进行评估(A),共同代表大脑中动脉的7个供血区域(M1-3段和岛状带,以及M4-6段)。当一个ASPECTS皮层区域与FVH(白色箭头)重合时,被认为是阳性。FVH评分范围从0(无FVH)到7(FVH与所有ASPECTS皮质区域相邻)。(a) 无FVH,FVH评分=0,(b) M2、M3、M5和I中可见FVH;FVH评分=4

本研究表明,在因LVO导致的梗死核心较大(ASPECTS≤5)的AIS患者中,由FVH-ASPECTS评分系统确定的良好侧支循环与良好的临床预后具有相关性,并且可以确定该患者群体中最有可能从血管重建中获益的患者。

 

原文出处:

Imad Derraz,Raed Ahmed,Isabelle Mourand.FLAIR vascular hyperintensities predict functional outcome after endovascular thrombectomy in patients with large ischemic cores.DOI:10.1007/s00330-022-08683-w

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    2023-04-09 kkunny
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    2022-09-14 feather89
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