急性缺血性脑卒中患者早期神经功能恶化的预测:基于MRI的高信号血管征、脑白质高信号体积及表观扩散系数OA
Prediction of early neurological deterioration in patients with acute ischemic stroke:based on MRI hyperintense vessel sign,white matter hyperintensity volume and apparent diffusion coefficient
目的 探讨基于MRI的高信号血管征(HVS)、脑白质高信号(WMH)体积及表观扩散系数(ADC)值对急性缺血性脑卒中(AIS)患者早期神经功能恶化(END)的预测价值.方法 收集2024年5月～2025年5月我院收治的AIS患者120例.根据入院7 d内是否发生END分为发生组(n=28)和未发生组(n=92).收集患者一般资料,检测中性粒细胞百分比(NEUT%)、高敏C反应蛋白(hs-CRP)、纤维蛋白原(FIB)、D-二聚体(D-D)等实验室参数.所有患者入院后24 h内完成头颅MRI检查,评估HVS阳性率、WMH体积及ADC值.分析MRI参数与END相关指标的相关性,采用ROC曲线评估HVS、WMH体积及ADC值对END的预测价值.结果 发生组的入院7 d内美国国立卫生研究院卒中量表(NIHSS)评分最大值未高于发生组(P<0.05).发生组NEUT%、FIB、D-D、hs-CRP高于未发生组(P<0.05).发生组的HVS阳性率更高,WMH体积更大,ADC值更低(P<0.05).AIS伴END患者HVS阳性率与入院7 d内NIHSS评分最大值呈正相关,WMH体积与NEUT%、D-D、hs-CRP、入院7 d内NIHSS评分最大值呈正相关,ADC值与NEUT%、D-D、入院7 d内NIHSS评分最大值呈负相关(P<0.05).联合预测AIS患者END的预测效能最高,约登指数为0.689,曲线下面积为0.898,敏感度、特异度分别为92.86%、76.09%.结论 基于MRI的HVS、WMH体积及ADC值与AIS患者END相关,三者联合检测对AIS患者END具有较高的预测价值,可为临床识别END患者提供参考.
Objective To investigate the predictive value of hyperintense vessel sign(HVS),white matter hyperintensity(WMH)volume and apparent diffusion coefficient(ADC)value based on MRI on early neurological deterioration(END)in patients with acute ischemic stroke(AIS).Methods A total of 120 patients with AIS admitted to the hospital from May 2024 to May 2025 were collected.According to whether END occurred within 7 days of admission,they were divided into occurrence group and non-occurrence group.The general data of patients were collected,and the laboratory parameters such as neutrophil percentage(NEUT%),high-sensitivity C-reactive protein(hs-CRP),fibrinogen(FIB)and D-dimer(D-D)were detected.All patients completed cranial MRI within 24 h after admission to evaluate the positive rate of HVS,WMH volume and ADC value.Pearson/Spearman correlation analysis was used to explore the correlation between MRI parameters and END-related indicators.Receiver operating characteristic curve was used to evaluate the predictive value of HVS,WMH volume and ADC value on END.Results The maximum National Institutes of Health Stroke Scale(NIHSS)score within 7 days of admission in occurrence group was higher than that in occurrence group(P<0.05).NEUT%,FIB,D-D and hs-CRP were higher in occurrence group than those in non-occurrence group(P<0.05).The positive rate of HVS in occurrence group was higher,and the volume of WMH was larger,and the ADC value was lower(P<0.05).The positive rate of HVS in AIS patients with END was positively correlated with maximum NIHSS score within 7 days of admission,and WMH volume was positively correlated with NEUT%,D-D,hs-CRP and maximum NIHSS score within 7 days of admission,and ADC value was negatively correlated with NEUT%,D-D and maximum NIHSS score within 7 days of admission(P<0.05).The combined prediction had the highest predictive efficiency on END in AIS patients,with a Youden index of 0.689,an area under the curve of 0.898,a sensitivity of 92.86%and a specificity of 76.09%.Conclusion MRI-based HVS,WMH volume and ADC value are associated with END in AIS patients.The combined detection of the three has high predictive value on END in AIS patients,and can provide a reference for clinical identification of END patients.
王秀萍;胡珊珊;黄银生
浙江大学医学院附属邵逸夫医院龙游分院神经内科,浙江 衢州 324400浙江大学医学院附属邵逸夫医院龙游分院神经内科,浙江 衢州 324400浙江大学医学院附属邵逸夫医院龙游分院神经内科,浙江 衢州 324400
急性缺血性脑卒中早期神经功能恶化磁共振成像高信号血管征脑白质高信号表观扩散系数
acute ischemic strokeearly neurological deteriorationmagnetic resonance imaginghyperintense vessel signwhite matter hyperintensityapparent diffusion coefficient
《分子影像学杂志》 2026 (5)
630-636,7
浙江省医药卫生科技计划项目(2023XY222)
评论