不同部位脑干分水岭梗死的血管狭窄及影像学标志物与不良预后的相关性OA

Objective To investigate the relationship between vascular stenosis,imaging markers[apparent diffusion coefficient(ADC),arterial spin labeling(ASL)-cerebral blood flow(CBF),diffusion kurtosis imaging(DKI)-mean kurtosis(MK)]and poor prognosis in brainstem watershed infarction at different sites.Methods According to the location of infarction,141 patients with brainstem watershed infarction were divided into 76 cases of pontine watershed infarction(PWI)group and 65 cases of lateral medullary watershed infarction(LMWI)group.The clinical characteristics,risk factors and clinical prognosis were compared between the two groups.Results Compared with those in LMWI group,basilar artery stenosis ratio,hypertension ratio,ADC<0.65 ratio and DKI-MK in PWI group were significantly increased,while vertebral artery stenosis ratio and ASL-CBF were significantly decreased(all P<0.05).Compared with those in LMWI group,the 3-month poor prognosis rate of the PWI group was significantly higher(χ2=19.644,P<0.001),and the 1-year recurrence rate was significantly lower(χ2=6.157,P=0.013).Basilar artery stenosis,hypertension and ADC<0.65 were independent risk factors for poor prognosis at 3 months after PWI(OR=4.396,95%CI:1.110-17.441,P=0.035;OR=4.884,95%CI:1.407-16.952,P=0.012;OR=5.339,95%CI:1.567-18.186,P=0.007).Vertebral artery stenosis was an independent risk factor for 1-year recurrence of LMWI(OR=3.379,95%CI:1.026-11.135,P=0.045).Conclusion There are differences in vascular stenosis and imaging markers(ADC,DKI-MK,ASL-CBF)in brainstem watershed infarction at different sites,and these differences are closely related to the poor prognosis of patients.