磁敏感征和不对称静脉征对急性大脑中动脉闭塞患者诊断价值

目的探讨磁共振磁敏感加权成像(SWI)的动脉磁敏感征(SVS)和不对称脉静脉血管征(AVS)对急性大脑中动脉闭塞(AMCAO)引起急性缺血性卒中(AIS)体积程度的预测研究和临床价值。方法45例AMCAO患者,根据阿尔伯塔卒中计划早期CT评分为基础的改良SWI-ASPECTS评分梗死病灶侧显著组和稀疏组以及无SVS组、SVS≤20 mmm组、>21 mm组进行SWI-ASPECTS评分量化,比较患者脑梗死体积程度的差异。结果45例AMCAO患者,无SVS者11例(占24.4%),有SVS征者34例(SVS≤20 mm为19例,SVS>20 mm为15例)(占75.6%)。无SVS组、SVS≤20 mm组、SVS>20 mm组,其脑梗死体积分别为(5.11±5.913)mm^3、(22.71±33.568)mm^3和(111.51±87.352)mm^3,三组梗死体积差异有显著统计学意义(P<0.001),三组梗死SWI-ASPECTS评分差异有显著统计学意义(P<0.01)。随着SVS长度增加,SWI-ASPECTS评分呈减小趋势(经Spearman检验,r=-0.538,P<0.001);AVS稀疏组19例(占42.2%),AVS显著组26例(占57.8%),其体积分别为(103.555±80.684)mm^3和(7.413±8.224)mm^3,经Mann-Whitney U检验,稀疏组的梗死体积大于显著组,差异有显著统计学意义(Z=-5.102,P<0.001)。结论SVS是颅内动脉严重狭窄或闭塞的标志,代表了血栓的存在及血管内新鲜凝血块形成、预测栓子成分。AVS代表急性颅脑大血管闭塞的脑缺血区周围软脑膜侧支循环的形成,AVS越广泛,SVS长度越小,梗死面积越小,SWI-ASPECTS评分越高患者的侧支循环分级越高。这对于患者最终梗死体积及临床预后的评估都具有重要意义。

The Diagnostic Value of Susceptibility Vessel Sign and Asymmetric Venous Sign in Patients with Acute Middle Cerebral Artery Occlusion

Objective To investigate the clinical value of the arterial magnetic sensitivity of the susceptibility vessel sign(SVS)and asymmetric pulse vein sign(AVS)on susceptibility weighted imaging(SWI)on acute middle cerebral artery occlusion(AMCAO)in predicting the Volume and cause of Acute Ischemic Stroke(AIS).Methods Forty-five AMCAO patients were subjected to SWI based on the improved SWI-ASPECTS score based on the early CT score of the Alberta Stroke Plan.-ASPECTS scores are quantified to compare the extent of cerebral infarction volume in patients.Results Among the 45 patients with AMCAO,there were 11 cases without SVS,accounting for 24.4%,and 34 cases with SVS signs(19 cases with SVS≤20 mm,15 cases with SVS>20 mm),accounting for 75.6%.Cerebral infarct volumes were(5.11±5.913)mm^3,(22.71±33.568)mm^3,and(111.51±87.352)mm^3 in the SVS-free group,SVS≤20 mm group,and SVS>20 mm group.The differences in infarct volume between the three groups were statistically significant(P<0.001).The SWI-ASPECTS scores of the three groups of infarctions were significantly different(P<0.01).As the length of SVS increased,the SWI-ASPECTS score showed a decreasing trend(spearman test,r=-0.538,P<0.001);19 cases in the AVS sparse group,accounting for 42.2%,26 cases in the AVS significant group,accounting for 57.8%,which The volumes were(103.555±80.684)mm^3 and(7.413±8.224)mm^3.According to the Mann-Whitney U test,the infarct volume in the sparse group was larger than that in the significant group,and the difference was statistically significant(Z=-5.102,P<0.001).Conclusion SVS is a sign of severe stenosis or occlusion of the intracranial arteries,which represents the presence of thrombus and the formation of fresh blood clots in the blood vessels,predicting the components of the emboli.AVS represents the formation of collateral circulation around the cerebral ischemic area with acute large cerebral vascular occlusion.The wider the AVS,the smaller the SVS length,the smaller the infarct size,and the higher the SWI-ASPECTS score,the higher the collateral circulation grade in patients.This has important implications for patients’final infarct volume and clinical prognosis.