急性缺血性卒中溶栓治疗前后磁敏感加权序列突出血管征的变化和意义

目的评估急性缺血性卒中患者溶栓治疗前后磁敏感加权成像(susceptibility-weighted imaging,SWI)的突出血管征(prominent vessel sign,PVS)的变化和意义。方法纳入34例急性大血管闭塞或严重狭窄的缺血性卒中溶栓患者,溶栓治疗前后均进行包括SWI序列的磁共振成像(magnetic resonance imaging,MRI)检查。根据血管再通情况分为再通组和未再通组,分别评估两组治疗前后责任血管供血区域的SWI-PVS分级和Alberta卒中项目早期计算机断层扫描(Alberta Stroke Program Early Computed Tomography,ASPECT)评分。采用Mann-Whitney U秩和检验分别比较再通组和未再通组溶栓治疗前后SWI-PVS和ASPECT的差异以及溶栓治疗后两组之间SWI-PVS和ASPECT的差异。结果 34例患者中22例溶栓后血管再通,12例血管未通。再通组溶栓治疗后SWI-PVS分级和ASPECT评分较治疗前改善(Z=3.852,P0.001;Z=3.852,P0.001)。未再通组溶栓治疗前后SWI-PVS分级和ASPECT评分均无显著差异。溶栓治疗后再通组SWI-PVS分级评分和ASPECT评分均较未再通组改善(Z=3.901,P0.001;Z=3.978,P0.001)。结论对于大血管闭塞或严重狭窄的急性缺血性卒中患者,SWI-PVS可以反映受累区域脑组织的低灌注状态,并可以用于评估溶栓治疗后受累脑组织的再灌注状态。

Signiifcance and Change in Prominent Vessel Sign on Susceptibility-weighted Imaging before and after Thrombolysis in Acute Ischemic Stroke

Objective To evaluate the significance and change in prominent vessel sign (PVS) on susceptibility-weighted imaging (SWI) before and after thrombolysis in acute ischemic stroke. Methods A total of 34 acute ischemic stroke patients with large vessel occlusion or severe stenosis who underwent SWI examination before and after thrombolytic therapy were enrolled in the study. The patients were divided into recanalization group and non-recanalization group. The SWI-PVS grade and Alberta Stroke Program Early Computed Tomography (ASPECT) Score of the two groups were evaluated before and after treatment. Mann-Whitney U rank sum test was used to compare the statistical difference of SWI-PVS in recanalization group and non-recanalization group before and after thrombolytic therapy, and the statistical difference of SWI-PVS between the two groups after thrombolytic therapy, respectively. Results The difference of the SWI-PVS grade and ASPECT score before and after thrombolytic therapy in recanalization group (22 cases) was statistically significant (Z=3.852,P<0.001;Z=3.852, P<0.001). The difference in non-recanalization group (12 cases) was not statistically significant (Z=3.852,P<0.001 andZ=3.852,P<0.001). The difference of SWI-PVS score and ASPECT score between the two groups after thrombolytic therapy was not statistically significant (Z=3.901,P<0.001;Z=3.978, P<0.001). Conclusion The PVS on SWI can be indicative and relfect hypo-perfusion status in acute ischemic stroke patients with large vessel occlusion or severe stenosis. It can be used to evaluate the reperfusion status after thrombolytic therapy.