FLAIR血管高信号征在大脑中动脉供血区急性脑梗死中的临床价值

目的探讨磁共振液体衰减反转恢复(FLAIR)序列高信号血管征(HVS)在评估大脑中动脉供血区急性脑梗死患者病情严重程度及预后中的应用价值。方法回顾性分析大脑中动脉供血区急性脑梗死的患者共52例。根据T2 FLAIR图像上血管高信号征是否存在分为有血管高信号征组和无血管高信号组。比较两组患者弥散序列(DWI)上梗死体积大小、入院时及治疗10天后NIHSS评分、早期神经功能恢复情况及基本临床资料。结果大脑中动脉供血区急性缺血性脑梗死患者52例中无远端HVS组35例(67%)和远端HVS组17例(33%)中,梗死体积大小分别为(89.74±28.82)和(73.15±26.37),入院时NIHSS评分分别为16(6~27)分及10(2~21)分,入院10天NIHSS评分分别为13(6-26)和8(0~19)分,无远端HVS组与远端HVS组差异存在统计学意义(P<0.05)。梗死侧大脑中动脉狭窄程度分为轻度狭窄、明显狭窄、闭塞,HVS组的发生率分别为19例(42%)、11例(73%),16例(89%)。HVS组中大脑中动脉严重狭窄或闭塞者27例,占HVS阳性组77%,血管高信号征阴性组中大脑中动脉严重狭窄或闭塞者5例,占HVS阴性组29%,两组之间存在显著差异(P<0.05)。结论 T2 FLAIR序列HVS是大脑中动脉供血区急性脑缺血性梗死重要的影像学征象。有远端HVS的患者急性梗死灶体积较小,NIHSS评分较低,临床预后较好。责任血管狭窄程度越严重,HVS的出现率越高。大脑中动脉区HVS联合MRA有利于临床评估脑梗死的病变范围、血管病变的大致位置、血管的狭窄程度,可指导临床进行早期干预,改善患者的预后。

The Value of FLAIR Hyperintense Vessel Sign of Middle Cerebral in the Diagnosis and Clinical Prognosis of Patients with Acute Ischemic Infarction

Objective To investigate the value of magnetic resonance fluid attenuated inversion recovery(FLAIR) sequence hyperintense vessel sign(HVS) in evaluating the severity and prognosis of acute ischemic stroke patients. Methods a retrospective analysis of 52 patients with acute ischemic infarction in acute middle cerebral artery territory who had neurological impairment and underwent clinical MR in December 2016 June 2017. All patients underwent 3.0 T GE cranial MR examination, including axial T1WI, axial and sagittal T2WI, diffusion-weighted imaging(DWI), axial T2 FLAIR and magnetic resonance angiography(MRA). According to the presence of hyperintense vessel sign, all cases were divided into hyperintense vessel sign group and non-hyperintense vessel sign group. Compare two groups in infarct size on DWI and the National Institutes of Health Stroke Scale(NIHSS) upon admission and after 10 days of treatment, early recovery of neurological function and basic clinical data, analyze the value of hyperintense vessel sign in the assessment of severity and prognosis in patients with acute ischemic infarction in the middle cerebral artery. Results There were 52 cases of acute ischemic cerebral infarction in middle cerebral artery territory, 31 males and 21 females, aged 32-89 years, with an average age of 62.98±13.08 years, HVS is observed in 35 of 52 patients(67%), and 17 cases(33%) without HVS. The infarct volume of No distal HVS group and distal HVS group were(89.74±28.82) and(73.15±26.37), initial NIHSS scores were 16(6~27) and 10(2~21), the 10 days NIHSS scores were 13(6~26) and 8(0~19), respectively. The distal HVS group and no distal HVS group has no significant difference(P<0.05). The stenosis degree of the brain artery is divided into 3 groups, mild stenosis, obvious stenosis and occlusion, the incidence of HVS were 42%(n=19), 73%(n=11), 89%(n=16), respectively. There were 27(77%) cases of severe stenosis or occlusion of middle cerebral artery in the HVS positive group, and 5(29%) cases in the HVS negative group. There was significant difference between the two groups(P<0.05). Conclusion HVS on T2 FLAIR sequence is an important imaging sign of middle cerebral artery territory acute ischemic infarction, which indicates severe stenosis or occlusion of intracranial large artery. The patients with distal HVS have smaller infarct size, lower NIHSS score and better clinical prognosis. The higher degree of middle cerebral arterial stenosis has the higher incidence of HVS. The reason of Middle cerebral artery region distal HVS of acute ischemic cerebral infarction may be the leptomeningeal collateral circulation in reverse blood flow after the brain artery stenosis or occlusion. The combination of middle cerebral artery HVS and MRA is helpful for clinical evaluation of the extent of cerebral infarction, the location of vascular lesions and the degree of stenosis, which can prompt the physician to take early clinical intervention and improve the prognosis of patients.