Abstract:

Objective　To evaluate chronic middle cerebral artery occlusion (CMCAO) by asymmetrically veins sign (AVS) on susceptibility weighted angiography (SWAN), to investigate the manifestation of AVS in patients with different collateral circulation status, and to evaluate the predictive ability of AVS for prognosis of CMCAO. Methods　A total of 39 patients with CMCAO, 25 males and 14 females, aged 46-90 (67.18±10.167) years, were enrolled in Lianyungang TCM Hospital Affiliated to Nanjing University of Chinese Medicine from January 2017 to February 2022. All patients underwent conventional magnetic resonance imaging (MRI), three dimensional time of flight magnetic resonance angiography (3D TOF-MRA), and SWAN examination. According to the improved regional leptomeningeal collateral (rLMC) score, namely SWAN-rLMC score, the patients were divided into a poor group (SWAN-rLMC score >12 points) and a good group (SWAN-rLMC score ≤12 points). The area under receiver operating characteristic curve (ROC) was used to evaluate the predictive ability of different sequences of rLMC scores for poor prognosis. Independent sample t test and χ² test were used. Results　Among the 39 CMCAO patients, 23 cases (58.97%) were on the left side and 16 cases (41.03%) on the right side. SWAN-rLMC score showed that there were 20 cases (51.28%) with poor collateral circulation and 19 cases (48.72%) with good collateral circulation. The rate of good prognosis was 89.5% (17/19) in the good collateral circulation group and 10.0% (2/20) in the poor collateral circulation group, and the difference was statistically significant (χ²=24.633, P<0.001). The area under the curve (AUC) value of SWAN-rLMC score for poor prognosis was 0.886 (95%CI: 0.761-1.000), showing a statistically significant difference (P<0.001), indicating good predictive value for poor prognosis. Conclusions　AVS is more common in patients with poor collateral circulation of CMCAO. Improved SWAN-rLMC score helps to predict and evaluate the prognosis in patients with CMCAO and provides valuable information for clinical treatment.

Key words: Chronic middle cerebral artery occlusion, Asymmetrically veins sign, Collateral circulation, Susceptibility weighted angiography

摘要： 目的　磁敏感加权血管成像（susceptibility weighted angiography，SWAN）上的不对称脉静脉血管征（asymmetrically veins sign，AVS）评估慢性大脑中动脉闭塞（chronic middle cerebral artery occlusion，CMCAO），探讨不同侧支循环状态患者的AVS显示情况，并评价AVS对CMCAO预后的预测能力。方法　收集在2017年月1月至2022年2月间于南京中医药大学连云港附属医院的CMCAO患者39例，男25例，女14例，年龄46～90（67.18±10.167）岁。所有患者行常规磁共振成像（magnetic resonance imaging，MRI）、三维时间飞跃法磁共振血管成像（three dimensional time of flight magnetic resonance angiography，3D TOF-MRA）及SWAN检查，根据改良区域性软脑膜侧支（regional leptomeningeal collateral，rLMC）评分，即SWAN-rLMC评分将患者分为不良组（SWAN-rLMC评分>12分）和良好组（SWAN-rLMC评分≤12分）。利用受试者工作特征曲线（ROC）下的面积（AUC）大小来评估不同序列rLMC评分判断不良预后的预测能力。采用独立样本t检验、χ²检验。结果　在39例CMCAO患者中，左侧23例（58.97%），右侧16例（41.03%）。SWAN-rLMC评分侧支循环不良组20例、占51.28%，良好组19例、占48.72%。侧支循环良好组的良好预后率为89.5%（17/19），不良组为10.0%（2/20），差异有统计学意义（χ²=24.633，P<0.001）。SWAN-rLMC评分判断不良预后的AUC值为0.886（95%CI：0.761～1.000），差异有统计学意义（P<0.001），对判断不良预后具有很好的预测价值。结论　CMCAO侧支循环不良组患者AVS更常见，通过改良SWAN-rLMC评分有助于CMCAO患者预后预测评估，并为临床治疗提供有价值的信息。

关键词: 慢性大脑中动脉闭塞, 不对称脉静脉血管征, 侧支循环, 磁敏感加权血管成像