HR-MRI影像特征及定量参数对缺血性脑梗死发生风险的预测价值

doi:10.3760/cma.j.issn.1007-1245.2023.13.011

国际医药卫生导报 ›› 2023, Vol. 29 ›› Issue (13): 1823-1827.DOI: 10.3760/cma.j.issn.1007-1245.2023.13.011

HR-MRI影像特征及定量参数对缺血性脑梗死发生风险的预测价值

李勇¹ 张红丽¹ 孙光达¹ 冯博²

¹聊城市第三人民医院影像科，聊城　252000；²聊城市第三人民医院神经内科，聊城　252000

收稿日期:2023-01-11 出版日期:2023-07-01 发布日期:2023-07-21
通讯作者: 冯博，Email：gg20232023@163.com
基金资助:
山东省医药卫生科技发展计划项目（202003071453）

Value of HR-MRI image characteristics and quantitative parameters in predicting the risk of ischemic cerebral infarction

Li Yong¹, Zhang Hongli¹, Sun Guangda¹, Feng Bo²

¹Imaging Department, Liaocheng Third People's Hospital, Liaocheng 252000, China; ²Neurology Department, Liaocheng Third People's Hospital, Liaocheng 252000, China

Received:2023-01-11 Online:2023-07-01 Published:2023-07-21
Contact: Feng Bo, Email: gg20232023@163.com
Supported by:
Shandong Province Medical Health Science and Technology Development Plan Project (202003071453)

摘要/Abstract

摘要：

目的　探讨高分辨率磁共振成像（HR-MRI）影像特征、定量参数对缺血性脑梗死发生风险的预测价值，分析其对临床早期诊断的影响。方法　本方案按对照试验、前瞻性、单盲、单中心临床研究方法设计。选取2020年3月至2022年3月聊城市第三人民医院收治的83例短暂性脑缺血发作患者，均行HR-MRI检查，根据1周内是否发生缺血性脑梗死分为发生组［32例，男18例、女14例，年龄（64.81±7.36）岁］、未发生组［51例，男28例、女23例，年龄（65.14±7.53）岁］。对比两组HR-MRI影像特征［斑块分布、斑块特征（斑块面积、斑块负荷）］、HR-MRI定量参数［血管最狭窄处面积（VA_MLN）、血管面积（VA_reference）、血管最狭窄处管壁面积（WA_MLN）、血管最狭窄处管腔面积（LA_MLN）、参考血管腔面积（LA_reference）及狭窄率］、重构方式（重构指数、正性重构、负性重构、无明显重构）。斑块分布、重构方式以χ²检验，斑块特征、HR-MRI定量参数以t检验；采用受试者工作特征曲线（ROC）分析HR-MRI影像特征、定量参数对缺血性脑梗死发生风险的预测价值。结果　发生组斑块面积［（6.43±3.06）mm²］、斑块负荷［（29.17±7.42）%］均大于未发生组［（5.37±1.02）mm²、（24.18±5.45）%］，差异均有统计学意义（t=2.287、3.525，均P<0.05）。发生组正性重构率［81.25%（26/32）］高于未发生组［52.94%（27/51）］，差异有统计学意义（χ²=6.827，P=0.009）。发生组WA_MLN［（12.04±2.02）mm²］、狭窄率［（32.46±2.02）%］均高于未发生组［（10.63±1.41）mm²、（21.20±1.35）%］，LA_MLN［（10.22±1.75）mm²］低于未发生组［（11.96±2.07）mm²］，差异均有统计学意义（t=3.744、30.462、3.949，均P<0.001）。斑块面积、斑块负荷、WA_MLN、LA_MLN、狭窄率预测缺血性脑梗死发生的曲线下面积（AUC）分别为0.839（95%CI 0.794～0.942）、0.706（95%CI 0.598～0.820）、0.773（95%CI 0.694～0.893）、0.819（95%CI 0.809～0.894）、0.812（95%CI 0.731～0.910），均在0.7以上，且各项指标、参数联合预测缺血性脑梗死发生风险的AUC值［0.947（95%CI 0.873～0.961）］最高。结论　HR-MRI斑块面积、斑块负荷、WA_MLN、LA_MLN及狭窄率对缺血性脑梗死发生风险具有较高预测价值，有利于临床对缺血性脑梗死的早期诊断、干预。

关键词:

缺血性脑梗死, 短暂性脑缺血发作, 高分辨率磁共振成像, 血管最狭窄处管腔面积, 重构指数

Abstract:

Objective　To investigate the value of high-resolution magnetic resonance imaging (HR-MRI) image characteristics and quantitative parameters in predicting the risk of ischemic cerebral infarction, and analyze its influence on early clinical diagnosis. Methods　This protocol was designed according to the method of controlled trial, prospective, single-blind, and single-center clinical study. A total of 83 patients with transient ischemic attack admitted to Liaocheng Third People's Hospital from March 2020 to March 2022 were selected for HR-MRI examination. According to whether ischemic cerebral infarction occurred within one week, they were divided into an occurrence group [32 patients, 18 males and 14 females, aged (64.81±7.36) years] and a non-occurrence group [51 patients, 28 males and 23 females, aged (65.14±7.53) years]. The HR-MRI image characteristics [plaque distribution and plaque characteristics (plaque area and plaque load)], HR-MRI quantitative parameters [area of the narrowest part of blood vessel (VA_MLN), vascular area (VA_reference), wall area of the narrowest part of blood vessel (WA_MLN), lumen area of the narrowest part of blood vessel (LA_MLN), reference lumen area (LA_reference), and stenosis rate], and reconstruction modes (reconstruction index, positive reconstruction, negative reconstruction, and no significant reconstruction) of the two groups were compared. χ² test was used for plaque distribution and reconstruction mode, and t test for plaque characteristics and HR-MRI quantitative parameters. The receiver operating characteristic curve (ROC) was used to analyze the predictive value of HR-MRI image characteristics and quantitative parameters in the risk of ischemic cerebral infarction. Results　The plaque area [(6.43±3.06) mm²] and plaque load [(29.17±7.42)%] in the occurrence group were higher than those in the non-occurrence group [(5.37±1.02) mm² and (24.18±5.45)%], with statistically significant differences (t=2.287 and 3.525, both P<0.05). The positive reconstruction rate in the occurrence group [81.25% (26/32)] was higher than that in the non-occurrence group [52.94% (27/51)], with a statistically significant difference (χ²=6.827, P=0.009). The WA_MLN [(12.04±2.02) mm²] and stenosis rate [(32.46±2.02)%] in the occurrence group were higher than those in the non-occurrence group [(10.63±1.41) mm² and (21.20±1.35)%], while the LA_MLN [(10.22±1.75) mm²] was lower than that in the non-occurrence group [(11.96±2.07) mm²], with statistically significant differences (t=3.744, 30.462, and 3.949, all P<0.001). The areas under the curve (AUCs) of plaque area, plaque load, WA_MLN, LA_MLN, and stenosis rate for predicting ischemic cerebral infarction were 0.839 (95%CI 0.794-0.942), 0.706 (95%CI 0.598-0.820), 0.773 (95%CI 0.694-0.893), 0.819 (95%CI 0.809-0.894), and 0.812 (95%CI 0.731-0.910), all above 0.7. The AUC value [0.947 (95%CI 0.873-0.961)] of all indexes and parameters combined to predict the risk of ischemic cerebral infarction was the highest. Conclusion　HR-MRI plaque area, plaque load, WA_MLN, LA_MLN, and stenosis rate have high predictive values for the risk of ischemic cerebral infarction, which is helpful for the early diagnosis and intervention of ischemic cerebral infarction.

Key words:

Ischemic cerebral infarction, Transient ischemic attack, High resolution magnetic resonance imaging, Lumen area of the narrowest part of blood vessel, Reconstruction index

李勇张红丽孙光达冯博.

HR-MRI影像特征及定量参数对缺血性脑梗死发生风险的预测价值 [J]. 国际医药卫生导报, 2023, 29(13): 1823-1827.

Li Yong, Zhang Hongli, Sun Guangda, Feng Bo.

Value of HR-MRI image characteristics and quantitative parameters in predicting the risk of ischemic cerebral infarction [J]. International Medicine and Health Guidance News, 2023, 29(13): 1823-1827.

参考文献

[1] 黄守革,蔡正哲. 短暂性脑缺血发作进展为脑梗死的危险因素及预防措施[J]. 中国实用医药,2020,15(14):35-37.DOI:10.14163/j.cnki.11-5547/r.2020.14.013.
[2] 李明月,李自如,姚远,等. 急性缺血性卒中患者血管内治疗疗效的相关因素分析[J]. 国际医药卫生导报,2022,28(21):2969-2973.DOI:10.3760/cma.j.issn.1007-1245.2022. 21.003.
[3] 陈丽颖,余辉云,向入平,等. CTP参数对短暂性脑缺血发作近期进展为急性脑梗死的预测价值探讨[J]. 国际神经病学神经外科学杂志,2022,49(2):20-23.DOI:10.16636/j.cnki.jinn.1673-2642.2022.02.005.
[4] 俞茜,冯天保,王晓慧,等. 磁共振成像平扫、磁敏感加权成像诊断急性脑梗死临床价值对比研究[J]. 陕西医学杂志,2021,50(4):425-427.DOI:10.3969/j.issn.1000-7377. 2021.04.010.
[5] 马文斌,欧志强,江虹虹. 颈部血管超声与MSCT血管造影在评估急性脑梗死患者动脉系统中的应用价值[J]. 中国CT和MRI杂志,2021,19(6):19-20,25.DOI:10.3969/j.issn.1672-5131.2021.06.006.
[6] 杨帅,王小宜,胡平,等. 头颈动脉高分辨率MR血管壁成像在隐匿性卒中病因诊断的临床价值[J]. 临床放射学杂志,2020,39(10):1936-1940.DOI:10.13437/j.cnki.jcr.2020.10.008.
[7] Li ML, Lin QQ, Liu YT, et al. The clinical value of head-neck joint high-resolution vessel wall imaging in ischemic stroke[J].J Stroke Cerebrovasc Dis,2020,29(9):105062.DOI:10.1016/j.jstrokecerebrovasdis.2020.105062.
[8] Won SY, Cha J, Choi HS, et al. High-resolution intracranial vessel wall MRI findings among different middle cerebral artery territory infarction types[J].Korean J Radiol,2022,23(3):333-342.DOI:10.3348/kjr.2021.0615.
[9] 张君,马林. 重视高分辨率MRI新技术对颅内血管壁病变的研究[J]. 中华放射学杂志,2020,54(4):269-272.DOI:10.3760/cma.j.cn112149-20200207-00109.
[10] 高鑫,朱婉秋,刘福军,等. 高分辨血管MR成像对急性脑梗死患者大脑中动脉粥样硬化斑块的诊断价值[J]. 湖南师范大学学报(医学版),2020,17(3):69-72.DOI:10.3969/j.issn.1673-016X.2020.03.022.
[11] 罗力亚,刘翠青,耿丽洁,等. 不同剂量阿托伐他汀对高龄急性脑梗死患者血管内皮功能的影响[J]. 实用临床医药杂志,2021,25(16):103-106,111.DOI:10.7619/jcmp.20211235.
[12] Lee SH, Jung JM, Kim KY, et al. Intramural hematoma shape and acute cerebral infarction in intracranial artery dissection: a high-resolution magnetic resonance imaging study[J].Cerebrovasc Dis,2020,49(3):269-276.DOI:10.1159/000508027.
[13] 高利珍,钱玉泉,张冰,等. 急性脑梗塞高信号血管征对脑组织血流灌注及预后的影响[J]. 中国临床医学影像杂志,2020,31(5):305-309.DOI:10.12117/jccmi.2020.05.001.
[14] Song X, Wei Q, Zhao X, et al. Association between short-term blood pressure variability and intracranial atherosclerotic plaque vulnerability: a high-resolution magnetic resonance imaging study[J].J Atheroscler Thromb,2022,29(9):1383-1392.DOI:10.5551/jat.63164.
[15] 刘志强,臧召霞,吴珊珊,等. 高分辨MRI对颅内动脉粥样硬化斑块分布、厚度及稳定性的评估[J]. 脑与神经疾病杂志,2020,28(9):578-582.
[16] 朱友义,高律萍,曹成瑛,等. MRI-DWI、HR-MRI评估急性脑梗死患者相关高危斑块特征研究[J]. 中国临床医学影像杂志,2021,32(10):700-703.DOI:10.12117/jccmi.2021. 10.004.
[17] 秦鑫,冯志慧,许海娜,等. 高分辨率磁共振成像在急性脑梗死及短暂性脑缺血发作患者大脑中动脉粥样硬化斑块特征观察中的价值[J]. 中国医学装备,2022,19(8):57-61.DOI:10.3969/J.ISSN.1672-8270.2022.08.013.
[18] Liu S, Tang R, Xie W, et al. Plaque characteristics and hemodynamics contribute to neurological impairment in patients with ischemic stroke and transient ischemic attack[J].Eur Radiol,2021,31(4):2062-2072.DOI:10.1007/s00330-020-07327-1.
[19] 沈婷雯,何柳,周清清,等. 运用HR-MRI研究具有正性重构的基底动脉粥样硬化斑块特征[J]. 临床放射学杂志,2021,40(8):1454-1459.DOI:10.13437/j.cnki.jcr.2021.08.004.
[20] 陈奕双,彭晓容,黄飚,等. 基底动脉斑块特征与缺血性脑卒中相关性的HR-MRI研究[J]. 医学影像学杂志,2021,31(6):906-910.
[21] Lee HS, Jung JM, Yang HB, et al. Predicting stenosis aggravation in follow-up high-resolution magnetic resonance images of patients with intracranial atherosclerosis[J].Cerebrovasc Dis,2022,51(5):608-614.DOI:10.1159/000523725.
[22] 法特合·阿扎提,罕迦尔别克·库锟,王云玲,等.高分辨率血管壁成像在椎动脉粥样硬化斑块及血管壁改变中与急性脑梗死的关系研究[J].临床放射学杂志,2022,41(7):1207-1212.DOI:10.13437/j.cnki.jcr.2022.07.015.

HR-MRI影像特征及定量参数对缺血性脑梗死发生风险的预测价值

Value of HR-MRI image characteristics and quantitative parameters in predicting the risk of ischemic cerebral infarction

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