高分辨率磁共振血管壁成像定量评估缺血性脑卒中相关血管床斑块负荷对近期预后不良风险的预警价值OA

Objective To explore the early warning value of high-resolution magnetic resonance vessel wall imaging(HR-VWI)for quantitative assessment of ischemic stroke-related vascular bed plaque load on the risk of poor short-term prognosis.Methods Two hundred and twenty patients with ischemic stroke were followed up for 3 months.According to the mRS score,they were divided into good prognosis group and poor prognosis group.Baseline data and HR-VWI quantitative parameters were compared between the two groups.The relationship between HR-VWI quantitative parameters and short-term poor prognosis risk was analyzed.ROC curve was used to analyze the predictive value of HR-VWI quantitative parameters and clinical factors for short-term poor prognosis risk.Results Compared with those in good prognosis group,the age,time from onset to admission,NIHSS score,vessel wall area,stenosis degree,plaque burden and remodeling index in the poor prognosis group were significantly increased,and GCS score was significantly decreased(all P<0.05).Logistic regression analysis showed that age,time from onset to admission,NIHSS score,GCS score,vessel wall area,stenosis degree,plaque burden,and remodeling index were independent influencing factors for the short-term poor prognosis risk in patients with ischemic stroke(all P<0.05).Smooth curve fitting showed that the vessel wall area,stenosis degree,and plaque burden were linearly related to the risk of poor short-term prognosis in patients with ischemic stroke(β=0.049,95%CI:0.033-0.066;β=0.010,95%CI:0.006-0.013;β=0.086,95%CI:0.064-0.107).There was a"U"-shaped curve relationship between the remodeling index and the risk of poor short-term prognosis in patients with ischemic stroke.Using threshold effects and computer simulation resampling techniques,the inflection point was calculated to be 1.05.When the reconstruction index was<1.05,the risk of poor short-term prognosis decreased as the reconstruction index increased;when the reconstruction index was≥1.05,the risk of poor short-term prognosis increases as the reconstruction index increases.ROC curve showed that the AUC of vessel wall area,stenosis degree,plaque burden and remodeling index in predicting the risk of poor short-term prognosis in patients with ischemic stroke was 0.808,0.777,0.781 and 0.799,respectively,which was significantly higher than the AUC of age and time from onset to admission(0.727 and 0.736,respectively)(all P<0.05),and close to the AUC of NIHSS score and GCS score(0.790 and 0.788,respectively).The ROC curve analysis showed that the AUC of the M2 prediction model was 0.939,which was significantly higher than that of the M1 prediction model(0.851),with a statistically significant difference(Z=2.938,P=0.003).Conclusion The quantitative assessment of plaque burden in the vascular bed associated with ischemic stroke using HR-VWI can be used to predict poor short-term prognosis,providing a reference for early clinical prediction of the risk of poor prognosis and targeted intervention plans.