缺血性中风患者中液体衰减反转恢复序列高信号动脉的临床预后：一项系统评价和荟萃分析
Clinical prognosis of FLAIR hyperintense arteries in ischaemic stroke patients: a systematic review and meta-analysis.
作者信息
Zhou Zien, Malavera Alejandra, Yoshimura Sohei, Delcourt Candice, Mair Grant, Al-Shahi Salman Rustam, Demchuk Andrew M, Wardlaw Joanna M, Lindley Richard I, Anderson Craig S
机构信息
Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
出版信息
J Neurol Neurosurg Psychiatry. 2020 May;91(5):475-482. doi: 10.1136/jnnp-2019-322625. Epub 2020 Mar 26.
OBJECTIVE
We performed a systematic review and meta-analysis to determine the association of fluid-attenuated inversion recovery (FLAIR) hyperintense arteries (FLAIR-HAs) on brain MRI and prognosis after acute ischaemic stroke (AIS).
METHODS
We searched Medline, Embase and Cochrane Central Register of Controlled Trials for studies reporting clinical or imaging outcomes with presence of FLAIR-HAs after AIS. Two researchers independently assessed eligibility of retrieved studies and extracted data, including from the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Outcomes were unfavourable functional outcome (primary, modified Rankin scale scores 3-6 or 2-6), death, intermediate clinical and imaging outcomes. We performed subgroup analyses by treatment or types of FLAIR-HAs defined by location (at proximal/distal middle cerebral artery (MCA), within/beyond diffusion-weighted imaging (DWI) lesion) or extent.
RESULTS
We included 36 cohort studies (33 prospectively collected) involving 3577 patients. FLAIR-HAs were not associated with functional outcome overall (pooled risk ratio 0.87, 95% CI 0.71 to 1.06), but were significantly associated with better outcome in those receiving endovascular therapy (0.56, 95% CI 0.41 to 0.75). Contrary to FLAIR-HAs at proximal MCA or within DWI lesions, FLAIR-HAs beyond DWI lesions were associated with better outcome (0.67, 95% CI 0.57 to 0.79). FLAIR-HAs favoured recanalisation (1.21, 95% CI 1.06 to 1.38) with increased risk of intracerebral haemorrhage (2.07, 95% CI 1.37 to 3.13) and early neurological deterioration (1.93, 95% CI 1.30 to 2.85).
CONCLUSIONS
FLAIR-HAs were not associated with functional outcome overall but were associated with outcome after endovascular therapy for AIS. FLAIR-HAs were also associated with early recanalisation or haemorrhagic complications, and early neurologic deterioration.
PROSPERO REGISTRATION NUMBER
CRD42019131168.
目的
我们进行了一项系统评价和荟萃分析，以确定脑磁共振成像（MRI）上的液体衰减反转恢复序列（FLAIR）高信号动脉（FLAIR-HAs）与急性缺血性卒中（AIS）后预后之间的关联。
方法
我们检索了医学期刊数据库（Medline）、荷兰医学文摘数据库（Embase）和考克兰系统评价数据库（Cochrane Central Register of Controlled Trials），以查找报告AIS后出现FLAIR-HAs的临床或影像学结果的研究。两名研究人员独立评估检索到的研究的合格性并提取数据，包括来自强化血压控制与溶栓治疗卒中研究（ENCHANTED）的数据。结局指标为不良功能结局（主要指标，改良Rankin量表评分3-6分或2-6分）、死亡、中期临床和影像学结局。我们根据治疗方法或由位置（大脑中动脉（MCA）近端/远端、弥散加权成像（DWI）病灶内/外）或范围定义的FLAIR-HAs类型进行亚组分析。
结果
我们纳入了36项队列研究（33项前瞻性收集），涉及3577例患者。总体而言，FLAIR-HAs与功能结局无关（合并风险比0.87，95%置信区间0.71至1.06），但与接受血管内治疗的患者的较好结局显著相关（0.56，95%置信区间0.41至0.75）。与MCA近端或DWI病灶内的FLAIR-HAs相反，DWI病灶外的FLAIR-HAs与较好结局相关（0.67，95%置信区间0.57至0.79）。FLAIR-HAs有利于再通（1.21，95%置信区间1.06至1.38），但脑出血风险增加（2.07，95%置信区间1.37至3.13）以及早期神经功能恶化风险增加（1.93，95%置信区间1.30至2.85）。
结论
总体而言，FLAIR-HAs与功能结局无关，但与AIS血管内治疗后的结局相关。FLAIR-HAs还与早期再通或出血性并发症以及早期神经功能恶化相关。
国际前瞻性系统评价注册编号
CRD42019131168。
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