目的 探讨液体衰减反转恢复序列（FLAIR）信号强度比值（SIR）对急性缺血性脑卒中患者发病时间≤4。5 h的预测价值。 方法 回顾性选择南京医科大学附属南京医院神经内科自2020年1月至2023年6月收治的180例急性缺血性脑卒中患者，采用低灌注强度比值（HIR）评估患者的侧支循环，将患者分为侧支循环丰富组和侧支循环不丰富组，比较2组患者临床资料和影像学指标的差异。采用单因素和多因素Logistic回归分析明确急性缺血性脑卒中患者发病时间≤4。5 h的影响因素。采用相关性检验分析急性缺血性脑卒中患者SIR与发病时间的相关性。应用受试者工作特征（ROC）曲线分析SIR、弥散加权成像（DWI）-FLAIR不匹配对急性缺血性脑卒中患者发病时间≤4。5 h的预测效能。 结果 180例患者中侧支循环丰富100例，侧支循环不丰富80例。与侧支循环丰富组比较，侧支循环不丰富组患者有高脂血症者占比较多、治疗前DWI梗死体积较大、灌注加权成像（PWI）-DWI不匹配体积较大、SIR较高，差异均有统计学意义（P<0。05）。180例患者中发病时间≤4。5 h 76例，发病时间>4。5 h 104例；单因素Logistic回归分析显示高脂血症、治疗前DWI梗死体积、DWI-FLAIR不匹配、HIR及SIR是急性缺血性脑卒中患者发病时间≤4。5 h的影响因素，差异均有统计学意义（P<0。05）。多因素Logistic回归分析显示高脂血症（OR=6。654，95%CI：5。751~8。824，P<0。001）、HIR（OR=0。724，95%CI：0。521~1。321，P=0。041）及SIR（OR=739。881，95%CI：383。296~14 258。065，P<0。001）是急性缺血性脑卒中患者发病时间≤4。5 h的独立影响因素。相关性检验显示急性缺血性脑卒中患者SIR与发病时间呈正相关关系（r=0。420，P<0。05），侧支循环不丰富组患者SIR与发病时间呈正相关关系（r=0。781，P<0。05）。ROC曲线分析显示SIR预测侧支循环不丰富组患者发病时间≤4。5 h的ROC曲线下面积（AUC）为0。917（95%CI：0。814~1。000，P<0。001），DWI-FLAIR不匹配预测侧支循环不丰富组患者发病时间≤4。5 h的AUC为0。530（95%CI：0。509~0。757，P=0。075），二者预测效能的差异有统计学意义（P<0。05）。 结论 HIR、SIR较低的急性缺血性脑卒中患者发病时间≤4。5 h几率更高，在侧支循环不丰富的患者中SIR可更为准确地预测急性缺血性脑卒中发病时间。 Objective To investigate the predictive value of fluid-attenuated inversion recovery (FLAIR) signal strength ratio (SIR) in onset time≤4。5 h in patients with acute ischemic stroke。 Methods A retrospective analysis was performed 180 acute ischemic stroke patients admitted to Department of Neurology， Nanjing Hospital Affiliated to Nanjing Medical University from January 2020 to June 2023 were chosen。 Hypoperfusion intensity ratio (HIR) was used to evaluate the collateral circulation (poor collateral circulation: HIR≤0。4 good collateral circulation: HIR>0。4) clinical data and imaging indexes between poor collateral circulation and good collateral circulation groups were compared。 Univariate and multivariate Logistic regressions were used to analyze the influencing factors for onset time≤4。5 h in patients with acute ischemic stroke。 Correlation between SIR and onset time was analyzed in patients with acute ischemic stroke。 Role of HIR as agency between SIR and onset time was explored。 Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of SIR and diffusion weighted imaging (DWI)-FLAIR mismatch in onset time≤4。5 h in acute ischemic stroke patients。 Results Of the 180 patients， 100 were into the good collateral circulation group and 80 were into the poor collateral circulation group compared with the good collateral circulation group， the poor collateral circulation group had significantly higher percentage of patients with hyperlipidemia， larger DWI infarction volume before treatment， larger perfusion weighted imaging (PWI)-DWI mismatch volume and higher SIR (P<0。05)。 In these 180 patients， 76 had onset time≤4。5 h and 104 had onset time>4。5 h。 Univariate Logistic regression analysis showed that hyperlipidemia， DWI infarct volume before treatment， DWI-FLAIR mismatch， HIR and SIR were influencing factors for onset time≤4。5 h in acute ischemic stroke patients (P<0。05)。 Multivariate Logistic regression analysis showed that hyperlipidemia (OR=6。654， 95%CI: 5。751-8。824， P<0。001)， HIR (OR=0。724， 95%CI: 0。521-1。321， P=0。041) and SIR (OR=739。881， 95%CI: 383。296-14 258。065， P<0。001) were independent influencing factors for onset time≤4。5 h in acute ischemic stroke patients。 Pearson correlation analysis showed that SIR was positively correlated to onset time in patients with acute ischemic stroke (r=0。420， P<0。05)， and SIR was positively correlated to onset time in patients from poor collateral circulation group (r=0。781， P<0。05)。 ROC curve showed that AUC of SIR in predicting onset time≤4。5 h was 0。917 (95%CI: 0。814-1。000， P<0。001) and that of DWI-FLAIR mismatch in predicting onset time≤4。5 h was 0。530 (95%CI: 0。509-0。757， P=0。075) in poor collateral circulation group， enjoying significant difference in predictive efficacy。 Conclusion Acute ischemic stroke patients with low HIR and SIR have higher odds of onset time≤4。5 h SIR can more accurately predict the onset time in these patients with poor collateral circulation。
Predictive value of FLAIR signal intensity ratio in onset time≤4.5 h in acute ischemic stroke patients with poor collateral circulation
Objective To investigate the predictive value of fluid-attenuated inversion recovery (FLAIR) signal strength ratio (SIR) in onset time≤4.5 h in patients with acute ischemic stroke. Methods A retrospective analysis was performed 180 acute ischemic stroke patients admitted to Department of Neurology, Nanjing Hospital Affiliated to Nanjing Medical University from January 2020 to June 2023 were chosen. Hypoperfusion intensity ratio (HIR) was used to evaluate the collateral circulation (poor collateral circulation: HIR≤0.4 good collateral circulation: HIR>0.4) clinical data and imaging indexes between poor collateral circulation and good collateral circulation groups were compared. Univariate and multivariate Logistic regressions were used to analyze the influencing factors for onset time≤4.5 h in patients with acute ischemic stroke. Correlation between SIR and onset time was analyzed in patients with acute ischemic stroke. Role of HIR as agency between SIR and onset time was explored. Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of SIR and diffusion weighted imaging (DWI)-FLAIR mismatch in onset time≤4.5 h in acute ischemic stroke patients. Results Of the 180 patients, 100 were into the good collateral circulation group and 80 were into the poor collateral circulation group compared with the good collateral circulation group, the poor collateral circulation group had significantly higher percentage of patients with hyperlipidemia, larger DWI infarction volume before treatment, larger perfusion weighted imaging (PWI)-DWI mismatch volume and higher SIR (P<0.05). In these 180 patients, 76 had onset time≤4.5 h and 104 had onset time>4.5 h. Univariate Logistic regression analysis showed that hyperlipidemia, DWI infarct volume before treatment, DWI-FLAIR mismatch, HIR and SIR were influencing factors for onset time≤4.5 h in acute ischemic stroke patients (P<0.05). Multivariate Logistic regression analysis showed that hyperlipidemia (OR=6.654, 95%CI: 5.751-8.824, P<0.001), HIR (OR=0.724, 95%CI: 0.521-1.321, P=0.041) and SIR (OR=739.881, 95%CI: 383.296-14 258.065, P<0.001) were independent influencing factors for onset time≤4.5 h in acute ischemic stroke patients. Pearson correlation analysis showed that SIR was positively correlated to onset time in patients with acute ischemic stroke (r=0.420, P<0.05), and SIR was positively correlated to onset time in patients from poor collateral circulation group (r=0.781, P<0.05). ROC curve showed that AUC of SIR in predicting onset time≤4.5 h was 0.917 (95%CI: 0.814-1.000, P<0.001) and that of DWI-FLAIR mismatch in predicting onset time≤4.5 h was 0.530 (95%CI: 0.509-0.757, P=0.075) in poor collateral circulation group, enjoying significant difference in predictive efficacy. Conclusion Acute ischemic stroke patients with low HIR and SIR have higher odds of onset time≤4.5 h SIR can more accurately predict the onset time in these patients with poor collateral circulation.
Acute ischemic strokeFluid-attenuated inversion recoverySignal strength ratioOnset time
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