Page 83 - 磁共振成像2024年7期电子刊

临床研究｜｜Clinical Articles 磁共振成像 2024年7月第15卷第7期 Chin J Magn Reson Imaging, Jul, 2024, Vol. 15, No. 7

基于低灌注强度比值的侧支循环对晚期时间窗

急性脑卒中预后预测的研究

陈乾，彭明洋，王同兴，陈国中，殷信道，任军 *

作者单位 南京医科大学附属南京医院（南京市第一医院）医学影像科，南京 210006
* 通信作者 任军，E-mail: renjun1203@163.com
中图分类号 R445.2；R743.3 文献标识码 A DOI 10.12015/issn.1674-8034.2024.07.013
本文引用格式 陈乾, 彭明洋, 王同兴, 等 . 基于低灌注强度比值的侧支循环对晚期时间窗急性脑卒中预后预测的研究[J]. 磁共振
成像, 2024, 15(7): 76-80, 93.
[摘要] 目的 以急性脑卒中患者数字减影血管造影（digital subtraction angiography, DSA）为侧支循环标准，探讨低灌注强度
比值（hypoperfusion intensity ratio, HIR）在晚期时间窗急性脑卒中患者血管内治疗后预后的预测价值。材料与方法 回顾性分
析 2020 年 1 月至 2023 年 3 月在本院行血管内治疗的晚期时间窗（6~24 h）急性脑卒中患者 160 例，侧支循环评分采用美国介入
和治疗神经放射学会（American Society of Interventional and Therapeutic Neuroradiology, ASITN）分级系统评估（侧支循环良好：
3~4级；侧支循环不良：0~2级）。HIR为脑血流达峰时间（time-to-maximum, T ）>10 s体积与T >6 s体积的比值。3个月预后
max max
采用改良 Rankin 量表（modified Rankin Scale, mRS）评分评估（预后良好：0~2 分；预后不良：3~6 分）。应用 Spearman 等级相
关分析及受试者工作特征（receiver operating characteristic, ROC）曲线分析HIR与侧支循环间的相关性及其在晚期时间窗急性脑
卒中患者预后中的预测价值。结果 与侧支循环良好组（n=90）相比，侧支循环不良组（n=70）的 HIR 值较高（0.45±0.07 vs.
0.30±0.08；P<0.001）、出血转化率较高（44.43% vs. 20.00%；P=0.003）、早期神经功能恶化率较高（45.71% vs. 23.33%；P=
0.003）及预后良好率较低（44.29% vs. 67.78%；P=0.030）。Spearman 相关分析显示 HIR 值与 ASITN 分级间具有良好的负相关
（预后良好组：r=−0.856；P<0.001；预后不良组：r=−0.888；P<0.001）；HIR 值与 3 个月 mRS 评分具有良好的正相关（r=0.773；
P<0.001）。多因素 logistic回归分析显示 HIR [OR（95% CI）：0.629（0.421~1.418）；P=0.041]为晚期时间窗急性脑卒中 EVT治疗
后预后的独立预测因子。ROC 曲线分析显示 ASITN 分级与 HIR 预测晚期时间窗急性卒中预后的预测效能差异无统计学意义
（AUC：0.837 vs. 0.887；Z=1.696，P=0.090）。结论 基于 HIR 的侧支循环评估可准确晚期时间窗急性脑卒中血管内治疗后预
后，为临床提供个性化治疗方案指导。
[关键词] 卒中；磁共振成像；灌注成像；预后；晚期时间窗
A study on predicting the outcome of acute stroke in late-time windows using collateral circulation
based on hypoperfusion intensity ratio

CHEN Qian, PENG Mingyang, WANG Tongxing, CHEN Guozhong, YIN Xindao, REN Jun *
Department of Radiology, Nanjing Hospital Affiliated to Nanjing Medical University (Nanjing First Hospital), Nanjing 210006, China
* Correspondence to REN J, E-mail: renjun1203@163.com
Received 18 Dec 2023, Accepted 3 Jun 2024; DOI 10.12015/issn.1674-8034.2024.07.013
ACKNOWLEDGMENTS National Natural Science Foundation of China (No. 82001811); China Postdoctoral Science Foundation (No.
2022M711664).
Cite this article as CHEN Q, PENG M Y, WANG T X, et al. A study on predicting the outcome of acute stroke in late-time windows
using collateral circulation based on hypoperfusion intensity ratio[J]. Chin J Magn Reson Imaging, 2024, 15(7): 76-80, 93.

Abstract Objective: To explore the predictive value of hypoperfusion intensity ratio (HIR) in the outcome of late-time windows acute
stroke patients after endovascular thrombectomy, using digital subtraction angiography (DSA) as collateral circulation standard.
Materials and Methods: A total of 160 acute stroke patients in late-time windows (6-24 hours) receiving endovascular thrombectomy
therapy in our study from January 2020 to March 2023 were analyzed retrospectively. American Society of Interventional and
Therapeutic Neuroradiology (ASITN) grading system was used to evaluate the collateral circulation (poor collateral circulation: 0-2
grade; good collateral circulation: 3-4 grade). HIR was defined as the ratio of the time-to-maximum (T )>10 s over T >6 s lesion
max
max
volumes. Modified Rankin Scale (mRS) score was used to evaluate the outcome at 3 months (good outcome: 0-2 score; poor outcome:
3-6 score). Spearman rank correlation and receiver operating characteristic (ROC) curve analysis were performed to evaluate the
predictive value in the outcome of acute stroke patients in the late-time windows. Results: Compared with the good collaterals group (n=
90), the poor collaterals group (n=70) had higher HIR values (0.45±0.07 vs. 0.30±0.08; P<0.001), higher hemorrhagic transformation
rates (44.43% vs. 20.00%; P=0.003), higher early neurological deterioration rates (45.71% vs. 23.33%; P=0.003), and lower good
outcome rates (44.29% vs. 67.78%; P=0.030). Spearman correlation analysis showed good negative correlation between HIR value and
ASITN grading (good outcome group: r=−0.856; P<0.001; poor outcome group: r=−0.888; P<0.001); the HIR value is positively correlated
with the mRS score at 3 month (r=0.773; P<0.001). Multivariate logistic regression analysis showed that HIR [OR (95% CI): 0.629
(0.421-1.418); P=0.041] is independent predictors of time from stroke onset. ROC curve analysis showed that there was no significant
statistical difference in the predictive efficacy of ASITN grading and HIR in predicting the outcome of acute stroke in the late-time window
(AUC: 0.837 vs. 0.887; Z=1.696, P=0.090). Conclusions: The evaluation of collateral circulation based on HIR can accurately predict the
outcome after endovascular treatment of acute stroke in the late-time windows, providing personalized treatment guidance for clinical practice.
Key words stroke; magnetic resonance imaging; perfusion imaging; outcome; late-time windows

收稿日期 2023-12-18 接受日期 2024-06-03
基金项目 国家自然科学基金项目（编号：82001811）；中国博士后科学基金项目（编号：2022M711664）

·76 · https://www.chinesemri.com