关键词:

慢性大脑中动脉闭塞, 区域性软脑膜侧支评分, 磁敏感加权血管成像, 三维伪连续动脉自旋标记, 预后

Abstract:

Objective　To investigate the clinical significance of regional leptomeningeal collateral (rLMC) score of susceptibility weighted angiography (SWAN) and cerebral blood flow (CBF) change of three dimensional pseudo continuous arterial spin labeling (3D-PCASL) in the prognosis assessment for patients with chronic middle cerebral artery occlusion (CMCAO). Methods　The clinical data of 35 patients with CMCAO admitted to Lianyungang TCM Hospital Affiliated to Nanjing University of Chinese Medicine from January 2017 to January 2022 were analyzed retrospectively, including 21 males and 14 females, aged (66.57±10.28) years. All patients underwent routine magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), SWAN, and 3D-pcASL examinations. The SWAN-rLMC score >12 points was defined as a poor collateral circulation (17 cases), and ≤12 points as a good collateral circulation (18 cases). Independent sample t test, Mann-Whitney U test, and χ² test were used to compare the data between the two groups, and the relationship between the good and bad SWAN-rLMC scores and CBF was analyzed. The area under the receiver operating characteristic curve (ROC-AUC) and the optimal cutoff value were used to evaluate the values of SWAN-rLMC score and CBF perfusion in determining the patients' prognosis. Results　Of the 35 patients with CMCAO, 15 were on the right side and 20 were on the left side. SWAN showed asymmetrical cortical venous sign (CVS) of posterior cerebral artery (PCA) in 26 cases, asymmetrical deep medullary vein (DMV) adjacent to lateral ventricle body in 21 cases, and both DMV and CVS dilation in 19 cases. Among the 18 cases with good SWAN-rLMC score, 12 cases had equal or high perfusion, while 16 cases had low perfusion in the 17 cases with poor SWAN-RLMC score. During follow-up, 17 patients had a poor prognosis [6 cases of cerebral infarction, 10 cases of transient ischemic attack (TIA), and 1 death]. According to the SWAN-rLMC score, the CBF of the affected side in the poor collateral circulation group [(31.76±10.72) ml·100 g^-1·min^-1] was lower than that in the good collateral circulation group [(48.82±18.63) ml·100 g^-1·min^-1], with a statistically significant difference (t=3.296, P<0.05). There was a statistically significant difference in the perfusion of the affected side between the good and poor collateral circulation groups (χ²=16.431, P<0.001). According to Mann-Whitney U test, the perfusion in the good collateral circulation group was better than that in the poor collateral circulation group, with a statistically significant difference (Z=3.660, P<0.001). The good prognosis rate of the good collateral circulation group with SWAN-rLMC score was higher than that of the poor collateral circulation group, and the good prognosis rate of the equal and high perfusion group was higher than that of the low perfusion group, with statistically significant differences (χ²=17.927 and 21.898, both P<0.001). The AUC values of SWAN-rLMC score and CBF perfusion in the assessment of poor prognosis were 0.858 and 0.882, respectively, with good recognition ability. The AUC value of the combination of SWAN-rLMC score and CBF perfusion was 0.954, with a statistically significant difference compared with AUC_SWAN-rLMC (Z=2.145, P<0.05). Conclusions　The improved SWAN-rLMC score and 3D-pcASL are imaging methods to evaluate collateral circulation, which can directly reflect the changes of cerebral oxygen metabolism, cerebral perfusion, and collateral circulation. The combined application of the two is conducive to providing individual quantitative basis for clinical prevention, treatment, and prognosis assessment, which has important clinical significance.

Key words:

Chronic middle cerebral artery occlusion, Regional leptomeningeal collateral score, Susceptibility weighted angiography, Three dimensional pseudo continuous arterial spin labeling, Prognosis