Fluid Attenuated Inversion Recovery Vascular Hyperintensity and Acute Ischemic Stroke: Correlation with Clinical and Imaging Finding

doi:10.3969/j.issn.1673-5765.2021.02.011

Abstract

Abstract:

Objective To explore the value of FLAIR vascular hyperintensity (FVH) in evaluating the degree of vascular stenosis, stroke severity and the location of infarction in patients with acute ischemic stroke (AIS). Methods A retrospective analysis was performed for the clinical and imaging data of AIS patients in middle cerebral artery (MCA) territory who were admitted to the Third Hospital of Hebei Medical University from January 2017 to June 2019. According to the distribution of infarcts in MCA territory on DWI, the infarcts were divided into perforating artery type, border zone type, regional type and mixed type. The FVH score (0-7 points) in MCA territory was calculated according to the method of ASPECT score, and all the patients were divided into FVH ≥4 group and FVH <4 group. The differences in general information, degree of vascular stenosis, NIHSS score on admission and infarcts site between the two groups were compared. Spearman correlation analysis was used to analyze the association between FVH score and artery stenosis degree, and ROC curve was used to analyze the diagnostic value of FVH score for artery occlusion.

Results A total of 214 patients were analyzed, including 51 patients with FVH ≥4 and 163 patients with FVH <4. The proportion of border zone infarcts (43.1% vs 20.9%) and intracranial carotid artery lesions (41.7% vs 22.3%) and the NIHSS score [4 (2-6) vs 3 (1-4)] in FVH ≥4 group were higher than that in FVH <4 group, while the proportion of perforating artery infarcts was lower than that in FVH <4 group (19.6% vs 52.8%), all the above differences were statistically significant. The proportion of artery occlusion in FVH ≥4 group was higher than that in FVH <4 group (54.9% vs 9.2%, P <0.001), and the proportion of mild artery stenosis was lower than that in FVH <4 group (9.8% vs 54.0%, P <0.001). Spearman analysis showed that FVH score was positively correlated with the degree of the ipsilateral internal carotid artery or MCA stenosis (r =0.504, P <0.001). ROC curve analysis indicated that the optimal cut-off value of FVH score for the diagnosis of artery occlusion was 3 points, the sensitivity was 74.4% and the specificity was 80.1%. Conclusions For patients with AIS in MCA territory, the FVH score can indirectly evaluate the degree of intracranial arterial stenosis, and also can reflect stroke severity on admission and infarcts site.

Key words: Fluid attenuated inversion recovery; Vascular hyperintensity; Intracranial atherosclerosis; Infarct pattern

摘要：

目的探讨FLAIR序列血管高信号（FLAIR vascular hyperintensity，FVH）征对急性缺血性卒中（acute ischemic stroke，AIS）患者动脉狭窄程度、卒中病情严重程度及梗死灶分布部位的评估价值。方法回顾性分析2017年1月-2019年6月在河北医科大学第三医院连续就诊的大脑中动脉（middle cerebral artery，MCA）供血区AIS患者的临床及影像学资料。依据DWI显示MCA供血区梗死灶的分布特点，将梗死分为穿支动脉型、分水岭型、区域型及混合型。利用ASPECT评分对MCA皮层供血区的划分方法，分别计算MCA各皮层区域FVH，计算FVH评分（0～7分）分值，并分为FVH≥4分和<4分两组。比较两组患者一般资料、血管狭窄程度、入院NIHSS评分及梗死部位差异。应用Spearman分析FVH评分与血管狭窄程度的相关性，ROC曲线分析FVH评分对血管闭塞的诊断价值。结果共纳入214例患者进行分析，FVH≥4分患者51例，<4分患者163例。FVH≥4分组分水岭梗死比例（43.1% vs 20.9%）、颈内动脉颅内段病变比例（41.7% vs 22.3%）、入院NIHSS评分[4（2～6）分 vs 3（1～4）分]均高于FVH<4分组，而穿支动脉梗死型比例（19.6% vs 52.8%）低于FVH<4分组，以上差异均有统计学意义。FVH≥4分组血管闭塞比例高于FVH<4分组（54.9% vs 9.2%，P＜0.001），血管轻度狭窄比例低于FVH<4分组（9.8% vs 54.0%，P＜0.001）。Spearman分析显示FVH评分与同侧颈内动脉颅内段及MCA狭窄程度呈正相关（r =0.504，P＜0.001）。ROC曲线分析示FVH评分预测血管闭塞的最佳界值为3分，其诊断血管闭塞的敏感度为74.4%，特异度为80.1%。结论对于MCA供血区AIS患者，FVH评分可间接评估颅内动脉狭窄程度，也可反映入院时卒中严重程度及梗死灶部位。

关键词: 液体衰减反转恢复; 血管高信号征; 颅内动脉粥样硬化; 梗死模式

ZHENG Yu-Ting, XU Yu-Zhu, LIU Jun-Yan. Fluid Attenuated Inversion Recovery Vascular Hyperintensity and Acute Ischemic Stroke: Correlation with Clinical and Imaging Finding[J]. Chinese Journal of Stroke, 2021, 16(02): 168-174.

郑玉庭，徐玉珠，刘俊艳. 液体衰减反转恢复序列血管高信号征与急性缺血性卒中的临床及影像学相关研究[J]. 中国卒中杂志, 2021, 16(02): 168-174.

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