缺血性卒中急性期磁敏感加权成像不对称突出静脉征的发生率及影响因素分析

doi:10.3969/j.issn.1673-5765.2022.10.009

摘要/Abstract

摘要：

目的探讨缺血性卒中（acute ischemic stroke，AIS）急性期头颅MRI SWI序列上不对称突出静脉征（asymmetrical prominent veins sign，APVS）的发生率及其影响因素。

方法前瞻性连续收集2021年7月-2022年3月在青岛大学附属烟台毓璜顶医院就诊的AIS患者。所有患者均在发病72 h内完成多模式头颅MRI检查，包括DWI、SWI和MRA序列，根据SWI上是否出现APVS，将患者分为APVS阳性组和APVS阴性组，收集患者年龄、性别、血管危险因素、入院时NIHSS、入院时平均动脉压、发病至MRI检查时间、颅内血管狭窄情况、梗死部位、TOAST分型及90 d不良预后（mRS＞1分）等资料，采用单因素分析和多因素logistic回归分析APVS的影响因素。

结果共入组80例患者，其中28例（35%）SWI序列上出现APVS。单因素分析显示，APVS阳性组患者的入院时NHISS[8（4～11）分 vs. 2（1～6）分，P＜0.001]、颅内血管重度狭窄或闭塞比例（57.1% vs. 3.8%，P＜0.001）、前循环梗死比例（92.9% vs. 65.4%，P=0.007）以及90 d不良预后比例（71.4% vs. 30.8%，P＜0.001）均高于APVS阴性组。多因素logistic回归分析显示，与APVS独立相关的因素为前循环梗死（OR 7.665，95%CI 1.089～53.959，P=0.041）、颅内血管重度狭窄或闭塞（OR 20.928，95%CI 3.420～128.056，P=0.001）。

结论前循环梗死、颅内血管重度狭窄或闭塞的AIS患者SWI序列上更易出现APVS。

文章导读： 本研究为前瞻性观察研究，使用了多变量分析校正混杂因素发现，前循环梗死、颅内血管重度狭窄或闭塞的AIS患者在卒中急性期更易在SWI序列上发现APVS。

关键词: 不对称突出静脉征; 磁共振成像; 磁敏感加权成像; 急性缺血性卒中

Abstract:

Objective To investigate the related factors leading to asymmetrical prominent veins sign (APVS) on SWI in patients with acute ischemic stroke (AIS).

Methods This prospective study enrolled the consecutive patients with AIS admitted to the Affiliated Yantai Yuhuangding Hospital of Qingdao University between July 2021 and March 2022. All patients completed multimodal MRI within 72 hours of symptoms onset, including DWI, SWI and MRA sequences. Patients were divided into APVS positive and negative groups according to having APVS on SWI or not. The baseline clinical data and 90-day poor prognosis (mRS>1) were collected. Multivariate logistic regression analysis was used to determine the factors affecting the presence of APVS.

Results A total of 80 patients were enrolled, with APVS on SWI occurring in 28 patients (35%). Univariate analysis showed that the NIHSS score [8 (4-11) vs. 2 (10-6), P<0.001], the proportion of severe intracranial large artery stenosis or occlusion (57.1% vs. 3.8%, P<0.001), anterior circulation infarction (92.9% vs. 65.4%, P=0.007), and poor prognosis (71.4% vs. 30.8%, P<0.001) in APVS positive group were higher than those in APVS negative group. Multivariate logistic regression analysis showed that anterior circulation infarction (OR 7.665, 95%CI 1.089-53.959, P=0.041), and severe intracranial large artery stenosis or occlusion (OR 20.928, 95%CI 3.420-128.056, P=0.001) were independent influencing factors of the occurrence of APVS.

Conclusions Patients with anterior circulation infarction and severe intracranial large artery stenosis or occlusion were more likely to have APVS on SWI.

Key words: Asymmetrical prominent veins sign; Magnetic resonance imaging; Susceptibility weighted imaging; Acute ischemic stroke

向薇, 徐璐瑶, 张曼曼, 魏红春, 梁志刚. 缺血性卒中急性期磁敏感加权成像不对称突出静脉征的发生率及影响因素分析[J]. 中国卒中杂志, 2022, 17(10): 1097-1102.

XIANG Wei, XU Luyao, ZHANG Manman, WEI Hongchun, LIANG Zhigang. The Frequency and Influencing Factors of Asymmetrical Prominent Veins Sign on Susceptibility-Weighted Imaging in Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2022, 17(10): 1097-1102.

参考文献

[1] PARK M G，YANG T I，OH S J，et al. Multiple hypointense vessels on susceptibility-weighted imaging in acute ischemic stroke：surrogate marker of oxygen extraction fraction in penumbra?[J]. Cerebrovasc Dis，2014，38（4）：254-261.
[2] LIU Y L，YIN H P，QIU D H，et al. Multiple hypointense vessels on susceptibility-weighted imaging predict early neurological deterioration in acute ischaemic stroke patients with severe intracranial large artery stenosis or occlusion receiving intravenous thrombolysis[J]. Stroke Vasc Neurol，2020，5（4）：361-367.
[3] CHEN C Y，CHEN C I，TSAI F Y，et al. Prominent vessel sign on susceptibility-weighted imaging in acute stroke：prediction of infarct growth and clinical outcome[J/OL]. PLoS One，2015，10（6）：e0131118[2022-04-02]. https://doi.org/10.1371/journal.pone.0131118.
[4] XIA S，UTRIAINEN D，TANG J，et al. Decreased oxygen saturation in asymmetrically prominent cortical veins in patients with cerebral ischemic stroke[J]. Magn Reson Imaging，2014，32（10）：1272-1276.
[5] DARWISH E A F，ABDELHAMEED-EL-NOUBY M，GENEIDY E. Mapping the ischemic penumbra and predicting stroke progression in acute ischemic stroke：the overlooked role of susceptibility weighted imaging[J/OL]. Insights Imaging，2020，11（1）：6[2022-04-02]. https://doi.org/10.1186/s13244-019-0810-y.
[6] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志，2018，51（9）：666-682.
[7] 《中国高血压防治指南》修订委员会. 中国高血压防治指南（2018年修订版）[J]. 中国心血管杂志，2019，24（1）：24-56.
[8] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南（2020年版）[J]. 中华糖尿病杂志，2021，13（4）：315-409.
[9] 中华医学会心血管病学分会介入心脏病学组，中华医学会心血管病学分会动脉粥样硬化与冠心病学组，中国医师协会心血管内科医师分会血栓防治专业委员会，等. 稳定性冠心病诊断与治疗指南[J]. 中华心血管病杂志，2018，46（9）：680-694.
[10] 中国成人血脂异常防治指南修订联合委员会. 中国成人血脂异常防治指南（2016年修订版）[J]. 中华心血管病杂志，2016，44（10）：833-853.
[11] JANUARY C T，WANN L S，CALKINS H，et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation：a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons[J/OL]. Circulation，2019，140（2）：e125-e151[2022-04-02]. https://doi.org/10.1016/j.jacc.2019.01.011.
[12] FIEBACH J B，AL-RAWI Y，WINTERMARK M，et al. Vascular occlusion enables selecting acute ischemic stroke patients for treatment with desmoteplase[J]. Stroke，2012，43（6）：1561-1566.
[13] LOU M，CHEN Z，WAN J，et al. Susceptibility-diffusion mismatch predicts thrombolytic outcomes：a retrospective cohort study[J]. AJNR Am J Neuroradiol，2014，35（11）：2061-2067.
[14] MORITA N，HARADA M，UNO M，et al. Ischemic findings of T2*-weighted 3-tesla MRI in acute stroke patients[J]. Cerebrovas Dis，2008，26（4）：367-375.
[15] JENSEN-KONDERING U，BöHM R. Asymmetrically hypointense veins on T2*w imaging and susceptibility-weighted imaging in ischemic stroke[J]. World J Radiol，2013，5（4）：156-165.
[16] MUNDIYANAPURATH S，MöHLENBRUCH M，RINGLEB P A，et al. Posterior circulation acute stroke prognosis early computed tomography score using hypointense vessels on susceptibility weighted imaging independently predicts outcome in patients with basilar artery occlusion[J/OL]. PLoS One，2015，10（7）：e0132587[2022-04-02]. https://doi.org/10. 1371/journal.pone.0132587.
[17] LIU Z，LI Y. Cortical cerebral blood flow，oxygen extraction fraction，and metabolic rate in patients with middle cerebral artery stenosis or acute stroke[J]. AJNR Am J Neuroradiol，2016，37（4）：607-614.
[18] PAYABVASH S，BENSON J C，TALEB S，et al. Prominent cortical and medullary veins on susceptibility-weighted images of acute ischaemic stroke[J/OL]. Br J Radiol，2016，89（1068）：20160714[2022-04-02]. https://doi.org/10.1259/bjr.20160714.
[19] JIANG H F，ZHANG Y Q，PANG J X，et al. Factors associated with prominent vessel sign on susceptibility-weighted imaging in acute ischemic stroke[J/OL]. Sci Rep，2021，11（1）：5641[2022-04-02]. https://doi.org/10.1038/s41598-021-84269-8.
[20] 华蓓，班然然，陈军，等. 侧支循环状态对AIS皮质静脉征的评估及对预后的影响[J]. 国际医学放射学杂志，2022，45（1）：10-15.
[21] WANG Y，XIAO J J，ZHAO L，et al. The frequency and associated factors of asymmetrical prominent veins：a predictor of unfavorable outcomes in patients with acute ischemic stroke[J/OL]. Neural Plast，2021，2021：9733926[2022-04-02]. https://doi.org/10.1155/2021/9733926.
[22] LI W，XIAO W M，LUO G P，et al. Asymmetrical cortical vein sign predicts early neurological deterioration in acute ischemic stroke patients with severe intracranial arterial stenosis or occlusion[J/OL]. BMC Neurol，2020，20（1）：331[2022-04-02]. https://doi.org/10.1186/s12883-020-01907-w.