Song Jiacheng, Ma Zhanlong, Meng Huan, Yu Jing, Li Yan, Hong Xunning, Shi Haibin
a Department of Radiology , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.
b Diagnostic Imaging , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.
Int J Neurosci. 2016 Nov;126(11):1030-5. doi: 10.3109/00207454.2015.1102139. Epub 2015 Oct 28.
Insula involvement in acute cerebral ischemia more likely causes penumbral loss and poor clinical outcome than infarct-sparing insula. Our objective was to prove the hypothesis that abundant collateral circulation represented by distal hyperintense vessels (HV) on MRI alleviates insula infarction and facilitates prognosis.
One hundred and fourteen stroke cases with M1 totally occlusion on MR angiography were documented consecutively from 2012 to 2014. The degree of HV was graded as absent, subtle or prominent. Clinical data were recorded retrospectively by reviewing the medical records. The infarct volume on diffusion-weighted image, along with National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS), was used to evaluate the clinical severity and prognosis.
The degree of HV was more abundant in insula-uninvolved stroke compared with stroke involving insula infarction (p = 0.026). Insula-involved stroke patients were older (p = 0.039) with a higher percentage of atrial fibrillation history (p = 0.042). Univariate analysis revealed that insula infarction, age, infarct volume and NIHSS predicted unfavorable prognosis of stroke, whereas HV had a favorable effect. The protective effect of HV was confirmed by multivariate analysis.
HV is a protective barrier between insula infarction and severity of clinical symptoms among stroke patients.
与未累及岛叶的梗死相比，岛叶受累于急性脑缺血更易导致半暗带丧失和临床预后不良。我们的目的是验证以下假设：MRI上由远端高信号血管（HV）所代表的丰富侧支循环可减轻岛叶梗死并改善预后。
连续记录了2012年至2014年114例磁共振血管造影显示M1段完全闭塞的中风病例。将HV的程度分为无、轻微或显著。通过查阅病历回顾性记录临床资料。采用弥散加权图像上的梗死体积，以及美国国立卫生研究院卒中量表（NIHSS）和改良Rankin量表（mRS）来评估临床严重程度和预后。
与累及岛叶梗死的中风相比，未累及岛叶的中风中HV程度更丰富（p = 0.026）。累及岛叶的中风患者年龄更大（p = 0.039），有房颤病史的比例更高（p = 0.042）。单因素分析显示，岛叶梗死、年龄、梗死体积和NIHSS可预测中风的不良预后，而HV有有益作用。多因素分析证实了HV的保护作用。
HV是中风患者岛叶梗死与临床症状严重程度之间的保护屏障。
