动脉自旋标记检测到的侧支循环可预测急性缺血性脑卒中的结局。
Collateral circulation detected by arterial spin labeling predicts outcome in acute ischemic stroke.
机构信息
Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China.
Neuropsychiatric Institute, Affiliated ZhongDa Hospital, Southeast University, Nanjing, China.
出版信息
Acta Neurol Scand. 2022 Nov;146(5):635-642. doi: 10.1111/ane.13694. Epub 2022 Sep 5.
BACKGROUND
Robust collateral circulation is strongly associated with good outcomes in acute ischemic stroke (AIS).
AIMS
To determine whether collateral circulation detected by arterial spin labeling (ASL) magnetic resonance imaging could predict good clinical outcome in AIS patients with 90 days follow-up.
MATERIALS AND METHODS
Total 58 AIS patients with anterior circulation stroke were recruited. Collateral circulation was defined as arterial transit artifact in ASL images. Modified Rankin Scale (mRS), the Barthel Index, and National Institutes of Health Stroke Scale (NIHSS) were employed to evaluate neurological function for the baseline and 90 days follow-up. The percent changes of these scores were also calculated, respectively. Finally, a support vector classifier model of machine learning and receiver operating characteristic curve were employed to estimate the power of ASL collaterals (ASLcs) predicting the clinical outcome.
RESULTS
Patients with ASLcs represented higher rate of good outcome (83.30% vs. 31.25%, p < .001) and lower follow-up mRS scores (p < .001), when compared to patients without ASLcs. There were significant differences for percent changes of mRS scores and NIHSS scores between these two groups. Further, the presence of ASLcs could predict good clinical outcome (OR, 1.54; 95% CI, 1.10-2.16), even after controlling for baseline NIHSS scores. The SVC model incorporating baseline NIHSS scores and ASLcs had significant predictive effect (accuracy, 79.3%; AUC, 0.806) on clinical prognosis for AIS patients.
DISCUSSION
We targeted on the non-invasive assessment of collateral circulation using ASL technique and found that patients with ASLcs were more likely to have a good clinical outcome after AIS. This finding is of guiding significance for treatment selection and prognostic prediction.
CONCLUSIONS
Early ASLcs assessment provides a good powerful tool to predict clinical outcome for AIS patients with 90 days follow-up.
背景
强大的侧支循环与急性缺血性脑卒中（AIS）的良好预后密切相关。
目的
确定通过动脉自旋标记（ASL）磁共振成像检测到的侧支循环是否可以预测 90 天随访的 AIS 患者的良好临床结局。
材料和方法
共纳入 58 例前循环卒中的 AIS 患者。侧支循环定义为 ASL 图像中的动脉转运伪影。采用改良 Rankin 量表（mRS）、Barthel 指数和美国国立卫生研究院卒中量表（NIHSS）评估基线和 90 天随访时的神经功能。还分别计算了这些评分的百分比变化。最后，采用机器学习的支持向量分类器模型和受试者工作特征曲线来评估 ASL 侧支（ASLcs）预测临床结局的能力。
结果
与无 ASLcs 的患者相比，有 ASLcs 的患者具有更高的良好结局率（83.30% vs. 31.25%，p<0.001）和较低的随访 mRS 评分（p<0.001）。两组间 mRS 评分和 NIHSS 评分的百分比变化有显著差异。此外，即使在控制基线 NIHSS 评分后，ASLcs 的存在也可以预测良好的临床结局（OR，1.54；95%CI，1.10-2.16）。纳入基线 NIHSS 评分和 ASLcs 的 SVC 模型对 AIS 患者的临床预后具有显著预测效果（准确性，79.3%；AUC，0.806）。
讨论
我们针对使用 ASL 技术对侧支循环进行非侵入性评估，并发现 ASLcs 的患者在发生 AIS 后更有可能获得良好的临床结局。这一发现对治疗选择和预后预测具有指导意义。
结论
早期 ASLcs 评估为 90 天随访的 AIS 患者提供了预测临床结局的有力工具。
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