黑血 MRI 上的血管壁增强可预测脑淀粉样血管病的急性和未来卒中。
Vessel Wall Enhancement on Black-Blood MRI Predicts Acute and Future Stroke in Cerebral Amyloid Angiopathy.
机构信息
From the Department of Radiology (J.S.M., A.S., M.D.A., S.-E.K.), Utah Center for Advanced Imaging Research, Utah
From the Department of Radiology (J.S.M., A.S., M.D.A., S.-E.K.), Utah Center for Advanced Imaging Research, Utah.
出版信息
AJNR Am J Neuroradiol. 2021 Jun;42(6):1038-1045. doi: 10.3174/ajnr.A7047. Epub 2021 Mar 18.
BACKGROUND AND PURPOSE
Cerebral amyloid angiopathy (CAA) is a known risk factor for ischemic stroke though angiographic imaging is often negative. Our goal was to determine the relationship between vessel wall enhancement (VWE) in acute and future ischemic stroke in CAA patients.
MATERIALS AND METHODS
This was a retrospective study of patients with new-onset neurologic symptoms undergoing 3T vessel wall MR imaging from 2015 to 2019. Vessel wall enhancement was detected on pre- and postcontrast flow-suppressed 3D T1WI. Interrater agreement was evaluated in cerebral amyloid angiopathy-positive and age-matched negative participants using a prevalence- and bias-adjusted kappa analysis. In patients with cerebral amyloid angiopathy, multivariable Poisson and Cox regression were used to determine the association of vessel wall enhancement with acute and future ischemic stroke, respectively, using backward elimination of confounders to < .20.
RESULTS
Fifty patients with cerebral amyloid angiopathy underwent vessel wall MR imaging, including 35/50 (70.0%) with ischemic stroke and 29/50 (58.0%) with vessel wall enhancement. Prevalence- and bias-corrected kappa was 0.82 (95% CI, 0.71-0.93). The final regression model for acute ischemic stroke included vessel wall enhancement (prevalence ratio = 1.5; 95% CI, 1.1-2.2; = .022), age (prevalence ratio = 1.02; 95% CI, 1.0-1.05; = .036), time between symptoms and MR imaging (prevalence ratio = 0.9; 95% CI, 0.8-0.9; < .001), and smoking (prevalence ratio = 0.7; 95% CI, 0.5-1.0; = .042) with c-statistic = 0.92 (95% CI, 0.84-0.99). Future ischemic stroke incidence with cerebral amyloid angiopathy was 49.7% (95% CI, 34.5%-67.2%) per year over a total time at risk of 37.5 person-years. Vessel wall enhancement-positive patients with cerebral amyloid angiopathy demonstrated significantly shorter stroke-free survival with 63.9% (95% CI, 43.2%-84.0%) versus 32.2% (95% CI, 14.4%-62.3%) ischemic strokes per year, chi-square = 4.9, = .027. The final model for future ischemic stroke had a c-statistic of 0.70 and included initial ischemic stroke (hazard ratio = 3.4; 95% CI, 1.0-12.0; = .053) and vessel wall enhancement (hazard ratio = 2.5; 95% CI, 0.9-7.0; = .080).
CONCLUSIONS
Vessel wall enhancement is associated with both acute and future stroke in patients with cerebral amyloid angiopathy.
背景与目的
脑淀粉样血管病（CAA）是缺血性卒中的已知危险因素，尽管血管造影成像通常为阴性。我们的目标是确定 CAA 患者中急性和未来缺血性卒中与血管壁增强（VWE）之间的关系。
材料与方法
这是一项回顾性研究，纳入了 2015 年至 2019 年期间因新发神经症状而接受 3T 血管壁磁共振成像检查的患者。使用预对比和后对比血流抑制 3D T1WI 检测血管壁增强。使用患病率和偏倚校正的 Kappa 分析评估 CAA 阳性和年龄匹配的阴性参与者之间的观察者间一致性。在 CAA 患者中，使用多元泊松和 Cox 回归来确定血管壁增强与急性和未来缺血性卒中的关系，使用向后消除混杂因素至 <.20。
结果
50 例 CAA 患者接受了血管壁磁共振成像检查，其中 35/50（70.0%）发生缺血性卒中，29/50（58.0%）存在血管壁增强。患病率和偏倚校正的 Kappa 值为 0.82（95%CI，0.71-0.93）。急性缺血性卒中的最终回归模型包括血管壁增强（优势比=1.5；95%CI，1.1-2.2； =.022）、年龄（优势比=1.02；95%CI，1.0-1.05； =.036）、症状与磁共振成像之间的时间（优势比=0.9；95%CI，0.8-0.9； <.001）和吸烟（优势比=0.7；95%CI，0.5-1.0； =.042），C 统计量为 0.92（95%CI，0.84-0.99）。在总计 37.5 人年的风险时间内，CAA 患者未来缺血性卒中的发生率为每年 49.7%（95%CI，34.5%-67.2%）。血管壁增强阳性的 CAA 患者卒中无复发生存时间明显缩短，每年缺血性卒中有 63.9%（95%CI，43.2%-84.0%），而 32.2%（95%CI，14.4%-62.3%），卡方=4.9， =.027。未来缺血性卒中的最终模型 C 统计量为 0.70，包括首发缺血性卒中（风险比=3.4；95%CI，1.0-12.0； =.053）和血管壁增强（风险比=2.5；95%CI，0.9-7.0； =.080）。
结论
血管壁增强与 CAA 患者的急性和未来卒中均相关。
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