脑小血管病总负荷评分联合3D-ASL技术在急性缺血性脑卒中患者静脉溶栓中的应用价值OA

Objective To investigate the value of total cerebral small vessel disease(CSVD)score combined with three-dimensional arterial spin labeling(3D-ASL)in predicting the prognosis of patients with acute ischemic stroke(AIS)after 90 days of intravenous thrombolysis.Methods A total of 189 AIS patients who were consecutively admitted to Department of Neurology,Changshu Hospital Affiliated to Nantong University,from January 2021 to June 2023 and underwent intravenous thrombolysis with al-teplase were enrolled,and multimodal brain MRI was performed to assess total CSVD load and cerebral blood flow in the area of re-sponsibility.A multivariate logistic regression analysis was used to identify the independent influencing factors for poor 90-day progno-sis in AIS patients undergoing intravenous thrombolysis.The receiver operating characteristic(ROC)curve was used to investigate the value of total CSVD score and 3D-ASL used alone or in combination in predicting the prognosis of AIS.Results The multivariate regression analysis showed that diabetes(OR=3.601,95%CI 1.448-8.954,P=0.006),total CSVD score≥3 points(OR=4.077,95%CI 1.785-9.313,P=0.001),and baseline NIHSS score(for every 1-point increase:OR=1.167,95%CI 1.061-1.283,P=0.001)were independent risk factors for poor prognosis in AIS patients on day 90 after intravenous thrombolysis,while ASL hyperper-fusion was an independent protective factor against poor prognosis(OR=0.16,95%CI 0.050-0.356,P=0.014).The ROC curve analysis showed that the predictive model based on CSVD score and ASL perfusion had a C-value of 0.844(95%CI 0.786-0.902,P<0.05)and thus had the best predictive efficacy.Conclusion Total CSVD score combined with 3D-ASL can more comprehen-sively reflect the whole brain circulation network and has a better effect than each indicator alone in predicting the 90-day prognosis of AIS patients undergoing intravenous thrombolysis.