摘要
目的 探讨头颅磁共振常规扫描诊断急性脑梗死价值及预测病情进展的作用.方法 选取 2021 年9 月至2024 年5 月收治的154 例疑似急性脑梗死患者,入院后均行头颅磁共振检查,以临床最终诊断结果 为准,分析头颅磁共振常规扫描对急性脑梗死诊断效能,根据病情是否进展分为进展组39 例、未进展组69 例,比较 2 组头颅磁共振常规扫描参数[最大病灶直径、病灶数量、白质疏松严重程度、颅内动脉狭窄、脑微出血、磁敏感加权成像(SWI)静脉不对称征、临床与弥散加权成像(DWI)不匹配征],分析头颅磁共振常规扫描参数对急性脑梗死病情进展的影响及评估价值.结果 临床最终诊断 109 例.以临床最终诊断结果 为准,头颅磁共振常规扫描诊断敏感度为 99.08%(108/109),特异度为97.78%(44/45),头颅磁共振常规扫描与临床最终诊断结果 的一致性为 98.70%(152/154),Kappa值为0.969(P＜0.001);进展组最大病灶直径大于未进展组,白质疏松严重程度重于未进展组,颅内动脉狭窄、脑微出血、SWI静脉不对称征、临床与DWI不匹配征患者占比高于未进展组(P＜0.01);最大病灶直径≥17.40 mm、白质疏松严重程度2+3 级、颅内动脉狭窄、脑微出血、SWI静脉不对称征、临床与DWI不匹配征的急性脑梗死患者病情进展的风险是最大病灶直径＜17.40 mm、白质疏松严重程度0+1 级、无颅内动脉狭窄、无脑微出血、无SWI静脉不对称征、无临床与DWI不匹配征患者的2.571、5.091、5.923、2.699、2.850、2.875 倍(P＜0.01);最大病灶直径、白质疏松严重程度、颅内动脉狭窄、脑微出血、SWI静脉不对称征、临床与DWI不匹配征评估急性脑梗死病情进展的曲线下面积分别为0.788、0.801、0.785、0.688、0.686、0.645,各参数联合评估急性脑梗死病情进展的曲线下面积最大,敏感度为97.44%,特异度为89.86%.结论 头颅磁共振常规扫描对急性脑梗死诊断及病情进展风险预测价值较高,可为临床制订后续干预方案提供参考,以改善患者预后.
Abstract
Objective To investigate the diagnostic value of conventional head magnetic resonance imaging(MRI)scan in acute cerebral infarction(ACI)and its value in predicting disease progression.Methods A total of 154 patients with suspected ACI were selected from September 2021 to May 2024,and all of them underwent head MRI after admission.Based on the final clinical diagnosis results,the efficacy of conventional head MRI scan in the diagnosis of ACI was analyzed.Ac-cording to the progression of the disease,they were divided into the progression group(n=39)and the non-progression group(n=69).The parameters of conventional head MRI scan[the maximum lesion diameter,number of lesions,severity of white matter osteoporosis,intracranial artery stenosis,brain microhemorrhage,magnetic susceptibility-weighted imaging(SWI)ve-nous asymmetry,clinical and diffusion-weighted imaging(DWI)mismatch]were compared between the two groups,to ana-lyze the effect of conventional head MRI scan parameters on the progression of ACI and its evaluation value.Results The fi-nal clinical diagnosis was 109 patients.Based on the final clinical diagnosis results,the diagnostic sensitivity and specificity of conventional head MRI scan were99.08%(108/109)and97.78%(44/45)respectively.The consistency between conven-tional head MRI scan and final clinical diagnosis results was 98.70%(152/154),and the Kappa value was 0.969(P＜0.001).The maximum lesion diameter in the progression group was greater than that in the non-progression group,the severi-ty of white matter osteoporosis was greater than that in the non-progression group,and the proportion of patients with intracra-nial artery stenosis,cerebral microhemorrhage,SWI venous asymmetry,and clinical mismatch with DWI was higher than that in the non-progression group(P＜0.01).The risk of progression in ACI patients with maximum lesion diameter≥17.40 mm,severity grade of white matter osteoporosis 2+3,intracranial artery stenosis,cerebral microhemorrhage,SWI venous asymmetry,and clinical mismatch with DWI was 2.571,5.091,5.923,2.699,2.850,and 2.875 times of patients with the maximum lesion diameter＜17.40 mm,severity grade of white matter osteoporosis0+1,no intracranial artery steno-sis,no cerebral microhemorrhage,no SWI venous asymmetry,and no clinical and DWI mismatch sign(P＜0.01).The area under the curve(AUC)of the maximum lesion diameter,severity of white matter osteoporosis,intracranial artery stenosis,cerebral microhemorrhage,SWI venous asymmetry and clinical and DWI mismatch for evaluating the progression of ACI was 0.788,0.801,0.785,0.688,0.686 and 0.645,respectively.The AUC of the above parameters in combination for evalua-ting the progression of ACI was the greatest,with sensitivity of 97.44%and specificity of 89.86%.Conclusion Convention-al head MRI scan has high diagnostic value for ACI,and high predictive value for the risk of disease progression.It can pro-vide reference for the development of follow-up intervention plans in clinical practice,so as to improve patient prognosis.
维普
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