European Radiology:在FLAIR上的这一征象可预测药物治疗的急性缺血性脑卒中患者的功能预后

2022-07-03 shaosai MedSci原创

流体衰减反转恢复血管高信号(FVHs)被认为是一种潜在的替代性影像学标志物,可以提供无创性可视化的脑膜侧支血流显示。

众所周知神经影像学在急性缺血性卒中(AIS)患者的疾病诊断及治疗方式选择方面起着关键作用。近年来,在可接受的时间窗内进行的血管内治疗(EVT)及其相关的预后改善已经得到广泛验证。由于起病不明确、初期临床严重程度较轻,许多有症状的大血管狭窄(LVS)患者最初仅仅接受药物治疗。因此,使用影像学标志物来研究AIS患者的功能恢复引起了临床上的广泛兴趣。

流体衰减反转恢复血管高信号(FVHs)被认为是一种潜在的替代性影像学标志物,可以提供无创性可视化的脑膜侧支血流显示虽然大多数研究都认为在急性缺血性卒中患者中常可观察到FVH的存在,但该征象的研究结果和临床意义并不一致。

近日,发表在European Radiology杂志的一项研究评估了FVH在预测接受药物治疗的患者在卒中发生后3个月长期预后方面的价值,同时探讨了影响FVH存在的相关因素,为卒中患者的早期识别及治疗评估提供了影像学支持。

本项研究纳入了2019年1月至2020年12月期间多个中心的前循环大血管狭窄(LVS)的连续AIS患者。评估了是否存在FVH,并定为FVH(+)。使用FVH-Alberta Stroke Program Early CT Score(ASPECTS)系统对FVH进行量化,并分为不同等级。FVH-ASPECTS为0=0级;1-2=1级;3-7=2级。功能不佳的定义为3个月时改良的Rankin量表>2。 

本研究共分析了175名患者(年龄,64.31±13.47岁;男性,65.1%),78.9%的患者表现为FVH。梗死体积较大(19.90毫升对5.50毫升,P<0.001)、FVH(+)比率较高(92.0%对65.9%,P<0.001)、FVH等级较高(2级,34.5%对10.2%,P<0.001)的患者更容易出现功能不佳的情况。梗死体积大于6.265毫升的FVH(+)(调整概率[aOR]6.03,95%置信区间[CI]1.82-19.98)和FVH等级(1级,aOR 3.07,95%CI 1.12-8.43;2级,aOR 5.80,95%CI 1.59-21.11)与不良功能预后独立有关。 

 
图 两个典型病例:a 右侧大脑中动脉闭塞的患者;DWI显示梗塞体积为25.48毫升,FVH-ASPECTS=4分,FVH等级=2;功能结局不佳(3个月mRS评分为4)。b 左侧大脑中动脉严重狭窄的患者;DWI显示梗死体积为5.3毫升,FVH-ASPECTS=0分,FVH等级=0,3个月的mRS评分为2,功能结果良好

本研究表明,基于DWI的梗死体积与FVH的存在和程度明显相关。FVH和梗死体积的组合对接受药物治疗的大动脉狭窄AIS患者的长期功能预后有独立的预测价值。

 

原文出处:

Jin-Hao Lyu,Sen-Hao Zhang,Xue-Yang Wang,et al.FLAIR vessel hyperintensities predict functional outcomes in patients with acute ischemic stroke treated with medical therapy.DOI:10.1007/s00330-022-08661-2

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    2023-03-19 feather89
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    2022-07-03 土豆你个马铃薯

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