DWI联合FLAIR序列动态参数对缺血性脑卒中静脉溶栓疗效及临床结局的预测价值OA

Objective To explore the changes in dynamic parameters of diffusion-weighted imaging(DWI)and fluid-attenuated inversion recovery(FLAIR)sequences in patients with ischemic stroke(IS)undergoing emergency intravenous thrombolysis and to evaluate their application value for the efficacy of intravenous thrombolysis and clinical outcomes.Methods A total of 134 IS patients admitted to Shunyi District Hospital,Beijing between April 2022 and April 2025 were retrospectively enrolled.All patients received emergency intravenous thrombolysis and underwent DWI and FLAIR sequence scans at admission and 24 hours after thrombolysis respectively.The relationship between dynamic changes in imaging parameters and 24-hour thrombolysis efficacy(assessed by △NIHSS)and 90 d clinical outcomes(assessed by the modified Rankin scale)was analyzed.Based on ΔNIHSS scores,patients were divided into a good efficacy group(≥2 points,53 cases)and a poor efficacy group(<2 points,81 cases)at 24 hours post-thrombolysis.According to Modified Rankin Scale scores,they were further categorized into an unfavorable outcome group(>2 points,61 cases)and a favorable outcome group(≤2 points,73 cases).Results The poor 24-hour intravenous thrombolysis efficacy group had higher lesion volume,△rSI-FLAIR,age,admission NIHSS score,and onset-to-door time than the good efficacy group,while △rADC was lower(P<0.05).Spearman correlation analysis showed that △rSI-FLAIR was positively correlated with △NIHSS(r=0.238,P<0.05),and △rADC was negatively correlated with △NIHSS(r=-0.387,P<0.05).Logistic regression analysis indicated that lesion volume,△rSI-FLAIR,age,admission NIHSS score,and onset-to-door time were independent risk factors for 24-hour thrombolysis efficacy,while △rADC was a protective factor(P<0.05).ROC curve analysis showed that the AUC of lesion volume,△rSI-FLAIR,and △rADC for evaluating 24-hour thrombolysis efficacy were 0.669,0.787,and 0.778,respectively.The poor 90 d outcome group had a higher proportion of posterior circulation ischemia,as well as higher lesion volume,△rSI-FLAIR,age,admission NIHSS score,and onset-to-door time than the good outcome group,while △rADC was lower(P<0.05).Logistic regression analysis showed that posterior circulation ischemia,onset-to-door time,lesion volume,△rSI-FLAIR,age,and admission NIHSS score were risk factors for 90 d outcomes,while △rADC was a protective factor(P<0.05).ROC curve analysis showed that the AUC of lesion volume,△rSI-FLAIR,and △rADC for predicting 90 d outcomes were 0.614,0.793,and 0.739,respectively.Conclusion Parameters of DWI and FLAIR sequences and their dynamic changes within 24 hours after thrombolysis can be used for quantitative assessment of short-term efficacy of intravenous thrombolysis in IS patients and have certain predictive value for 90 d clinical outcomes.