北京大学学报(医学版) ›› 2021, Vol. 53 ›› Issue (6): 1133-1138. doi: 10.19723/j.issn.1671-167X.2021.06.021

• 论著 • 上一篇    下一篇

大血管闭塞性脑卒中亚急性期磁敏感血管征的表现

任国勇1,2,吴雪梅2,李颖1,李婕妤1,孙伟平1,(),黄一宁1   

  1. 1.北京大学第一医院神经内科,北京 100034
    2.太原钢铁(集团)有限公司总医院神经内科,太原 030003
  • 收稿日期:2020-01-15 出版日期:2021-12-18 发布日期:2021-12-13
  • 通讯作者: 孙伟平 E-mail:swp_222@163.com
  • 基金资助:
    国家自然科学基金(81400944);北京大学交叉学科种子基金(BMU2018MX020)

Susceptibility vessel sign in subacute stroke patients with large vessel occlusion

REN Guo-yong1,2,WU Xue-mei2, 1,LI Jie-yu1,SUN Wei-ping1,(),HUANG Yi-ning1   

  1. 1. Department of Neurology, Peking University First Hospital, Beijing 100034, China
    2. Department of Neurology, General Hospital of Taiyuan Iron & Steel CO., LTD.(TISCO), Taiyuan 030003, China]
  • Received:2020-01-15 Online:2021-12-18 Published:2021-12-13
  • Contact: Wei-ping SUN E-mail:swp_222@163.com
  • Supported by:
    National Natural Science Foundation of China(81400944);Peking University Interdisciplinary Seed Funding(BMU2018MX020)

摘要:

目的:探讨不同病因所致的大血管闭塞性脑卒中患者在亚急性期磁敏感血管征(susceptibility vessel sign,SVS)的表现。方法:选择北京大学第一医院神经内科病房2017年12月—2019年8月收治的经磁共振血管成像、CT血管造影或数字减影血管造影证实存在颅内大血管闭塞,且在发病第3~14天接受磁敏感加权成像(susceptibility-weighted imaging,SWI)检查的卒中患者进行回顾性分析,对比心源性栓塞(cardioembolism,CE)和大动脉粥样硬化性卒中(large artery atherosclerosis,LAA)患者的SVS征出现情况。结果:共有51例患者进入分析,其中女19例、男32例,平均年龄(63.04±11.23)岁。两组患者在性别、高血压、糖尿病、冠心病、高脂血症、吸烟、入院美国国立卫生研究院卒中量表(National Institute of Health stroke scale, NIHSS)评分间差异均无统计学意义。与LAA组相比,CE组患者年龄更大,合并房颤的比例更高,差异有统计学意义(P<0.05)。共有30例患者表现为SVS征阳性,心源性栓塞组患者SVS征阳性率为30%,显著低于大动脉粥样硬化性卒中患者(65.9%),两组间差异有统计学意义(P=0.039)。在敏感度测试中仅纳入SWI检查时间在卒中后第7~14天的患者,两组间SVS征阳性率的差异仍有统计学意义(0 vs. 72.7%, P=0.006)。以有无房颤分组,合并房颤的卒中患者SVS征阳性率为25%,显著低于无房颤的卒中患者(65.1%),两组间差异有统计学意义(P=0.043)。结论:大动脉闭塞性脑卒中发病的亚急性期,心源性栓塞患者的SVS征阳性率低于LAA亚型的卒中患者;SVS征在卒中不同亚型鉴别中的作用尚需要进一步大样本的病例研究来验证。

关键词: 磁敏感加权成像, 大血管闭塞, 脑卒中, 病因分型, 亚急性期

Abstract:

Objective: To investigate the presentation of susceptibility vessel sign (SVS) in subacute stroke patients with large vessel occlusion. Methods: We collected consecutive stroke patients who were admitted to Peking University First Hospital from December 2017 to August 2019 retrospectively. Those who had intracranial large vessel occlusion and received sensitivity weighted imaging (SWI) within 3 to 14 days after stroke onset were included in our analysis. The diagnosis of large vessel occlusion was based on magnetic resonance angiography (MRA), CT angiography (CTA) or digital subtraction angiography (DSA). The demographic information, clinical characteristics and imaging results were obtained from medical record. The occurrence rates of SVS sign were compared between stroke patients with cardioembolism (CE) and large artery atherosclerosis (LAA). In the sensitivity analysis, we performed a subgroup analysis in those patients who received SWI within 7 to 14 days after stroke onset. We also compared the occurrence rate of SVS sign between the patients with and without atrial fibrillation. Results: A total of 51 patients, 19 females and 32 males, with an average age of (63.04±11.23) years were analyzed in this study. Compared with LAA group, the patients in CE group were older and more likely to have an atrial fibrillation (P<0.05). There were no significant differences between the CE group and LAA group in gender, hypertension, diabetes, coronary heart disease, hyperlipidemia, smoking, or National Institute of Health stroke scale(NIHSS) score at admission. SVS sign was found in 30 patients. Of whom, 3 were in CE group and 27 in LAA group. The occurrence rate of SVS sign was higher in the LAA group than in the CE group significantly (65.9% vs. 30.0%, P=0.039). The subgroup analysis showed that, in the patients who received SWI examination within 7 to 14 days after stroke onset, the differences between the two groups were still statistically significant (0 vs. 72.7%, P=0.006). Another sensitivity analysis showed that, the rate of SVS in the patients with atrial fibrillation was significantly lower than those patients without atrial fibrillation (25% vs. 65.1%, P=0.043). Conclusion: In subacute stroke patients, the occurrence rate of SVS sign in CE group was lower than that of LAA group. The significance of SVS sign in the differentiation of stroke subtype needs further validation.

Key words: Susceptibility-weighted imaging, Large vessel occlusion, Stroke, Etiological type, Subacute stage

中图分类号: 

  • R741

表1

心源性栓塞组与大动脉粥样硬化性卒中组患者基线资料比较"

Variable CE(n=10) LAA(n=41) t/χ2 P
Male, n(%) 5 (50.0) 27 (65.9) 0.319 0.572
Age/years, $\overline{x}$±s 70.60±13.53 61.20±9.94 2.495 0.016
Hypertension, n(%) 7 (70.0) 30 (73.2) 0.040 0.841
Diabetes mellitus, n(%) 6 (60.0) 21 (51.2) 0.021 0.884
Smoker, n(%) 4 (40.0) 23 (56.1) 0.315 0.573
Coronary heart disease, n(%) 2 (20.0) 7 (17.1) 0.046 0.830
Atrial fibrillation, n(%) 8 (80.0) 0 (0.00) - 0.000
Hyperlipidaemia, n(%) 5 (50.0) 26 (63.4) 0.175 0.676
NIHSS at admission, M(P25,P75) 2 (2, 6) 4 (2, 6) - 0.194

图1

不同闭塞血管的磁敏感血管征表现"

图2

不同时间点检测的磁敏感血管征"

表2

心源性栓塞组与大动脉粥样硬化性卒中组患者影像学检查比较"

Variable CE(n=10) LAA(n=41) t/χ2 P
Occluded artery MCA, n(%) 8 (80.0) 35 (85.4)
Others(ACA or PCA), n(%) 2 (20.0) 6 (14.6) 0.166 0.683
Interval from stroke onset to SWI/d, M(P25,P75) 6.50 (4.75, 9.00) 7.00 (5.00, 9.50) 0.774
SVS sign, n(%) 3 (30.0) 27 (65.9) 4.267 0.039
[1] Gorelick PB, Wong KS, Bae HJ, et al. Large artery intracranial occlusive disease: A large worldwide burden but a relatively neglected frontier[J]. Stroke, 2008, 39(8):2396-2399.
doi: 10.1161/STROKEAHA.107.505776 pmid: 18535283
[2] Ornello R, Degan D, Tiseo C, et al. Distribution and temporal trends from 1993 to 2015 of ischemic stroke subtypes: A systematic review and meta-analysis[J]. Stroke, 2018, 49(4):814-819.
doi: 10.1161/STROKEAHA.117.020031
[3] Tian C, Cao X, Wang J. Recanalisation therapy in patients with acute ischaemic stroke caused by large artery occlusion: Choice of therapeutic strategy according to underlying aetiological mechanism[J]. Stroke Vasc Neurol, 2017, 2(4):244-250.
doi: 10.1136/svn-2017-000090
[4] Allibert R, Billon GC, Vuillier F, et al. Advantages of susceptibility-weighted magnetic resonance sequences in the visualization of intravascular thrombi in acute ischemic stroke[J]. Int J Stroke, 2014, 9(8):980-984.
doi: 10.1111/ijs.12373 pmid: 25319168
[5] Cho KH, Kim JS, Kwon SU, et al. Significance of susceptibility vessel sign on T2*-weighted gradient echo imaging for identification of stroke subtypes[J]. Stroke, 2005, 36(11):2379-2383.
doi: 10.1161/01.STR.0000185932.73486.7a
[6] Horie N, Tateishi Y, Morikawa M, et al. Acute stroke with major intracranial vessel occlusion: Characteristics of cardioembolism and atherosclerosis-related in situ stenosis/occlusion[J]. J Clin Neurosci, 2016, 32(8):24-29.
doi: 10.1016/j.jocn.2015.12.043
[7] Kang DW, Jeong HG, Kim DY, et al. Prediction of stroke subtype and recanalization using susceptibility vessel sign on susceptibility-weighted magnetic resonance imaging[J]. Stroke, 2017, 48(6):1554-1559.
doi: 10.1161/STROKEAHA.116.016217
[8] Bourcier R, Derraz I, Delasalle B, et al. Susceptibility vessel sign and cardioembolic etiology in the THRACE trial[J]. Clin Neuroradiol, 2019, 29(4):685-692.
doi: 10.1007/s00062-018-0699-8 pmid: 29947813
[9] Adams HP, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment[J]. Stroke, 1993, 24(1):35-41.
pmid: 7678184
[10] Mori E, Yoneda Y, Tabuchi M, et al. Intravenous recombinant tissue plasminogen activator in acute carotid artery territory stroke[J]. Neurology, 1992, 42(5):976-982.
pmid: 1579252
[11] Molina CA, Montaner J, Abilleira S, et al. Timing of spontaneous recanalization and risk of hemorrhagic transformation in acute cardioembolic stroke[J]. Stroke, 2001, 32(5):1079-1084.
pmid: 11340213
[12] Fitzgerald S, Dai D, Wang S, et al. Platelet-rich emboli in cerebral large vessel occlusion are associated with a large artery atherosclerosis source[J]. Stroke, 2019, 50(7):1907-1910.
doi: 10.1161/STROKEAHA.118.024543 pmid: 31138084
[13] Sato Y, Ishibashi-Ueda H, Iwakiri T, et al. Thrombus components in cardioembolic and atherothrombotic strokes[J]. Thromb Res, 2012, 130(2):278-280.
doi: 10.1016/j.thromres.2012.04.008
[14] 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. 中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014[J]. 中华神经科杂志, 2015, 48(4):258-273.
[15] Patel AR, Patel AR, Desai S. The underlying stroke etiology: A comparison of two classifications in a rural setup[J]. Cureus, 2019, 11(7):51-57.
[16] Radbruch A, Mucke J, Schweser F, et al. Comparison of susceptibility weighted imaging and TOF-angiography for the detection of thrombi in acute stroke[J]. PLoS One, 2013, 8(5):634-639.
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