不对称突出静脉征在急性缺血性脑卒中患者早期神经功能恶化中的作用

The role of asymmetrical prominent veins sign in early neurological deterioration of acute ischemic stroke patients.

作者信息

Huang Kuankuan, Liu Jianfang, Yun Wenwei, Cao Yin, Zhang Min

机构信息

First People's Hospital in Guangyuan, Guangyuan, China.

Department of Neurology, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, China.

出版信息

Front Neurol. 2022 Aug 15;13:860824. doi: 10.3389/fneur.2022.860824. eCollection 2022.

DOI:10.3389/fneur.2022.860824

PMID:36046632

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9420992/

Abstract

BACKGROUND AND PURPOSE

Asymmetrical prominent veins sign (APVS) often appears on susceptibility-weighted angiography (SWAN) images in patients with acute stroke. Early neurological deterioration (END) is highly correlated with survival prognosis in patients with ischemic stroke. This study sought to explore the relationship between APVS and END in patients with acute stroke.

METHODS

The subjects retrospectively enrolled in this study were patients with acute ischemic stroke in the middle cerebral artery supply area. All patients underwent head MRI, including the SWAN sequence, within 7 days of stroke symptom onset. END was defined as clinical deterioration or recurrence within 72 h after ischemic stroke. The volume of infarction on diffusion-weighted imaging was measured. Univariate and multivariate analyses were used to analyze the relationship between APVS and END. Spearman correlation between APVS grades and infarct volume, white matter hyperintensity (WMH) volume, and offending vessel were also analyzed.

RESULTS

A total of 157 patients with middle cerebral artery infarct between September 2018 and April 2020 were included in the study. APVS appeared on MRI in 84 of 157 patients, and 34 of 157 patients were diagnosed with END. In patients with END, the proportion of severe APVS was higher than in patients without END ( = 0.001, = 14.659). Patients with END were older and had a larger volume of infarct and WMH than patients without END (all < 0.05). After adjustments were made for related risk factors of END, the severity of APVS was still related to END (OR = 2.56, 95% CI, 1.38-4.75; for trend = 0.003). Spearman correlation showed that APVS grades were positively related to infarct volume ( = 0.289, < 0.001) and 3-month modified Rankin Scale score ( = 0.203, = 0.011) and negatively related to offending vessels ( = -0.170, = 0.034).

CONCLUSION

APVS may be an important predictor of END in patients with acute ischemic stroke.

摘要

背景与目的

急性卒中患者的磁敏感加权血管造影（SWAN）图像上常出现不对称突出静脉征（APVS）。早期神经功能恶化（END）与缺血性卒中患者的生存预后高度相关。本研究旨在探讨急性卒中患者中APVS与END之间的关系。

方法

本研究回顾性纳入大脑中动脉供血区急性缺血性卒中患者。所有患者在卒中症状发作7天内均接受了头部MRI检查，包括SWAN序列。END定义为缺血性卒中后72小时内临床症状恶化或复发。测量弥散加权成像上的梗死体积。采用单因素和多因素分析来分析APVS与END之间的关系。还分析了APVS分级与梗死体积、白质高信号（WMH）体积以及责任血管之间的Spearman相关性。

结果

2018年9月至2020年4月期间共纳入157例大脑中动脉梗死患者。157例患者中84例MRI上出现APVS，157例患者中有34例被诊断为END。END患者中重度APVS的比例高于无END患者（ = 0.001， = 14.659）。与无END患者相比，END患者年龄更大，梗死体积和WMH体积更大（均 < 0.05）。在对END的相关危险因素进行校正后，APVS的严重程度仍与END相关（OR = 2.56，95%CI，1.38 - 4.75；趋势检验 = 0.003）。Spearman相关性分析显示，APVS分级与梗死体积呈正相关（ = 0.289， < 0.001），与3个月改良Rankin量表评分呈正相关（ = 0.203， = 0.011），与责任血管呈负相关（ = -0.170， = 0.034）。