Zheng Shuai, Ge Peicong, Li Yi, Wang Jingzhe, Shi Zhiyong, Zhang Jinghan, He Lei, Cheng Linggang, Zhang Dong, He Wen
Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2021 Feb 15;12:570843. doi: 10.3389/fneur.2021.570843. eCollection 2021.
To explore the association between ultrasound parameters and previous ischemic or hemorrhagic stroke in patients with moyamoya disease (MMD), and develop an ultrasound-based nomogram to identify stroke in patients with MMD. We prospectively enrolled 52 consecutive patients (92 hemispheres) with MMD at the Beijing Tiantan Hospital. Thirty-six patients (65 hemispheres) were assigned to the training dataset from September 2019 to February 2020, and 16 patients (27 hemispheres) were assigned to the validation dataset from March 2020 to July 2020. Multivariate logistic regression analysis was applied to identify ultrasound parameters associated with previous history of ipsilateral stroke in patients with MMD, and a nomogram was subsequently constructed to identify stroke in patients with MMD. The performance of the nomogram was evaluated with respect to discrimination, calibration, and clinical usefulness. Multivariate analysis indicated that the flow volume (FV) of the extracranial internal carotid artery (EICA) and the peak systolic velocity (PSV) of the posterior cerebral artery (PCA) were independently associated with ipsilateral stroke in patients with MMD, a nomogram incorporating these two parameters was constructed to identify stroke patients. The area under the receiver operating characteristic (AUROC) curves was 0.776 (95% CI, 0.656-0.870) in the training dataset and 0.753 (95% CI, 0.550-0.897) in the validation dataset suggested that the model had good discrimination ability. The calibration plot showed good agreement in both the two datasets. The decision curve analysis (DCA) revealed that the nomogram was clinically useful. Ultrasound parameters of EICA and PCA are independently associated with history of previous ipsilateral ischemic or hemorrhagic stroke in patients with MMD. The present ultrasound-based nomogram might provide information to identify MMD patients with high risk of stroke. Future long-term follow-up studies are needed to prove the predictive value in other independent cohorts. http://www.chictr.org.cn/index.aspx. Unique Identifier: ChiCTR1900026075.
为探讨烟雾病（MMD）患者超声参数与既往缺血性或出血性卒中之间的关联，并开发一种基于超声的列线图以识别MMD患者的卒中情况。我们在北京天坛医院前瞻性纳入了52例连续的MMD患者（92个半球）。2019年9月至2020年2月，36例患者（65个半球）被分配到训练数据集，2020年3月至2020年7月，16例患者（27个半球）被分配到验证数据集。应用多因素逻辑回归分析来识别与MMD患者既往同侧卒中史相关的超声参数，随后构建列线图以识别MMD患者的卒中情况。从区分度、校准度和临床实用性方面评估列线图的性能。多因素分析表明，颅外颈内动脉（EICA）的血流量（FV）和大脑后动脉（PCA）的收缩期峰值流速（PSV）与MMD患者的同侧卒中独立相关，构建了包含这两个参数的列线图以识别卒中患者。训练数据集的受试者操作特征（AUROC）曲线下面积为0.776（95%CI，0.656 - 0.870），验证数据集为0.753（95%CI，0.550 - 0.897），表明该模型具有良好的区分能力。校准图在两个数据集中均显示出良好的一致性。决策曲线分析（DCA）显示列线图具有临床实用性。EICA和PCA的超声参数与MMD患者既往同侧缺血性或出血性卒中史独立相关。目前基于超声的列线图可能为识别具有高卒中风险的MMD患者提供信息。未来需要长期随访研究来证实其在其他独立队列中的预测价值。http://www.chictr.org.cn/index.aspx。唯一标识符：ChiCTR1900026075。
