Song Xiaowei, Chen Wenwen, Zhao Xihai, Zheng Zhuozhao, Sang Zhenhua, Li Rui, Wu Jian
Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.
J Cent Nerv Syst Dis. 2024 Jul 24;16:11795735241266572. doi: 10.1177/11795735241266572. eCollection 2024.
Stroke patients with coexisting intracranial artery stenosis (ICAS) and white matter lesions (WML) usually have a poor outcome. However, how WML affects stroke prognosis has not been determined.
To investigate the quantitative forward flow at the middle cerebral artery in ICAS patients with different degrees of WML using 4D flow.
Single-center cross-sectional cohort study.
Ischemic stroke patients with symptomatic middle cerebral artery (MCA) atherosclerosis were included, and they were divided into 2 groups based on Fazekas scale on Flair image (mild group = Fazekas 0-2, and severe group = Fazekas >2), TOF-MRA and 4D flow were performed to quantify the stenosis degree and forward flow at the proximal of stenosis. The flow parameters were compared between different white matter hyperintensity (WMH) groups, as well as in different MCA stenosis groups, logistic regression was used to validate the association between forward flow and WMH.
A total of 66 patients were included in this study (mean age 56 years old, 68.2% male). 77.3% of them presented with WMH (Fazekas 1-5). Comparison of flow index between mild and severe WMH groups found a significantly lower forward flow (2.34 ± 1.09 vs 3.04 ± 1.35), higher PI (0.75 ± 0.43 vs 0.66 ± 0.32), and RI (0.49 ± 0.19 vs 0.46 ± 0.15) at ipsilateral infarction MCA in the severe WMH group, all -values <0.05. After adjusting for other covariates, forward mean flow at ipsilateral infarction MCA is still associated with severe WMH independently, OR = 0.537, 95% CI (0.294, 0.981), = 0.043.
Intracranial artery stenosis patients with coexisting severe WMH suffer from significantly decreased flow, which could explain the poor clinical outcome in this population, and also provide some insight into recanalization therapy in the future.
同时存在颅内动脉狭窄（ICAS）和白质病变（WML）的卒中患者通常预后较差。然而，WML如何影响卒中预后尚未明确。
使用四维血流技术研究不同程度WML的ICAS患者大脑中动脉的定量正向血流。
单中心横断面队列研究。
纳入有症状的大脑中动脉（MCA）动脉粥样硬化的缺血性卒中患者，根据液体衰减反转恢复序列（Flair）图像上的 Fazekas 量表将其分为两组（轻度组=Fazekas 0-2，重度组=Fazekas>2），进行时间飞跃磁共振血管造影（TOF-MRA）和四维血流检查以量化狭窄程度和狭窄近端的正向血流。比较不同白质高信号（WMH）组之间以及不同MCA狭窄组之间的血流参数，采用逻辑回归验证正向血流与WMH之间的关联。
本研究共纳入66例患者（平均年龄56岁，男性占68.2%）。其中77.3%存在WMH（Fazekas 1-5）。轻度和重度WMH组之间的血流指数比较发现，重度WMH组同侧梗死MCA处的正向血流明显降低（2.34±1.09对3.04±1.35），搏动指数（PI）较高（0.75±0.43对0.66±0.32），阻力指数（RI）较高（0.49±0.19对0.46±0.15），所有P值<0.05。在调整其他协变量后，同侧梗死MCA处的平均正向血流仍与重度WMH独立相关，比值比（OR）=0.537，95%置信区间（CI）（0.294，0.981），P=0.043。
同时存在重度WMH的颅内动脉狭窄患者血流明显减少，这可以解释该人群临床预后较差的原因，也为未来的再通治疗提供了一些思路。
