Wu Jiahua, Wang Peng, Zhou Leilei, Zhang Danfeng, Chen Qian, Mao Cunnan, Su Wen, Huo Yingsong, Peng Jin, Yin Xindao, Chen Guozhong
Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Quant Imaging Med Surg. 2022 Jan;12(1):688-698. doi: 10.21037/qims-21-337.
To investigate the relationship between fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH), hemodynamics, and functional outcome in atherosclerotic middle cerebral artery (MCA) stenosis using a computational fluid dynamics (CFD) model based on magnetic resonance angiography (MRA), according to a modified Rankin Scale (mRS) at 3 months.
A total of 120 patients with 50-99% atherosclerotic MCA stenosis were included. The training and internal validation groups were composed of 99 participants and 21 participants, respectively. Demographic, imaging data, and functional outcome (mRS at 3 months) were collected. Hemodynamic parameters were obtained from the CFD model. The FVH score was based on the number of territories where FVH is positive, according to the spatial distribution in the Alberta Stroke Program Early Computed Tomography Score (ASPECTS). The prediction models were constructed according to clinical and hemodynamic parameters using multivariate logistic analysis. The DeLong test compared areas under the curves (AUCs) of the models.
The multivariable logistic regression analysis showed that the National Institute of Health Stroke Scale (NIHSS) at admission, hypertension, hyperlipidemia, the ratio of wall shear stress before treatment (WSSR), and difference in the ratio of wall shear stress (WSSR) were independently associated with functional outcome (all P<0.05). In the training group before treatment, the AUC of model 1a (only clinical variables) and 2a (clinical variables with addition of WSSR) were 0.750 and 0.802. After treatment, the AUC of model 1b (only clinical variables) and 2b (clinical variables with addition of difference in WSSR) were 0.815 and 0.883, respectively. The AUC of models with hemodynamic parameters was significantly higher than the models based on clinical variables only (all P<0.05, DeLong test). In the internal validation group before treatment, the AUC of the model (clinical variables) was 0.782, and that of the model (clinical variables and WSSR) was 0.800. After treatment, the AUC of the model (clinical variables) was 0.833, and that of the model (clinical variables and difference in WSSR) was 0.861. There were no significant differences between the good and the poor functional outcome group concerning FVH scores before treatment (0.30±0.81 0.26±0.97; P=0.321) and FVH scores after treatment (0.08±0.39 0.00±0.00; P=0.244).
Hemodynamics was associated with functional outcomes in patients with ischemic stroke attributed to atherosclerotic MCA stenosis, while FVH was not. Hemodynamic parameters were of great importance in the prediction models.
使用基于磁共振血管造影（MRA）的计算流体动力学（CFD）模型，根据3个月时的改良Rankin量表（mRS），研究动脉粥样硬化性大脑中动脉（MCA）狭窄患者的液体衰减反转恢复（FLAIR）血管高信号（FVH）、血流动力学与功能结局之间的关系。
共纳入120例MCA动脉粥样硬化狭窄率为50%-99%的患者。训练组和内部验证组分别由99名参与者和21名参与者组成。收集人口统计学、影像学数据和功能结局（3个月时的mRS）。从CFD模型中获取血流动力学参数。FVH评分基于FVH阳性区域的数量，根据阿尔伯塔卒中项目早期计算机断层扫描评分（ASPECTS）中的空间分布确定。使用多变量逻辑分析根据临床和血流动力学参数构建预测模型。DeLong检验比较模型的曲线下面积（AUC）。
多变量逻辑回归分析显示，入院时的美国国立卫生研究院卒中量表（NIHSS）、高血压、高脂血症、治疗前壁面切应力比值（WSSR）以及壁面切应力比值差异（WSSR）与功能结局独立相关（均P<0.05）。在治疗前的训练组中，模型1a（仅临床变量）和2a（添加WSSR的临床变量）的AUC分别为0.750和0.802。治疗后，模型1b（仅临床变量）和2b（添加WSSR差异的临床变量）的AUC分别为0.815和0.883。包含血流动力学参数的模型的AUC显著高于仅基于临床变量的模型（均P<0.05，DeLong检验）。在治疗前的内部验证组中，模型（临床变量）的AUC为0.782，模型（临床变量和WSSR）的AUC为0.八零零。治疗后，模型（临床变量）的AUC为0.833，模型（临床变量和WSSR差异）的AUC为0.861。在功能结局良好组和不良组之间，治疗前FVH评分（0.30±0.81对0.26±0.97；P=0.321）和治疗后FVH评分（0.08±0.39对0.00±0.00；P=0.244）无显著差异。
血流动力学与动脉粥样硬化性MCA狭窄所致缺血性卒中患者的功能结局相关，而FVH与之无关。血流动力学参数在预测模型中具有重要意义。
