Comparative study of unilateral dominance and prominent vascular sign after unilateral middle cerebral artery occlusion in M1 segment
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摘要:
目的探讨单侧大脑中动脉M1段闭塞后，动脉偏侧优势与突出血管征（PVS）之间的相关性，并分析动脉偏侧优势及PVS与患者神经功能缺失程度之间的相关性。 方法收集2018年1月~2020年3月单侧大脑中动脉M1段闭塞的急性缺血性脑卒中患者48例，其中男性27例，女性21例，年龄38~78岁（52.8±7.7岁）。依据三维时间飞跃法磁共振血管成像提示有无患侧大脑前动脉和（或）大脑后动脉偏侧优势分为偏侧优势组（n=26）和对照组（n=22），观察两组患者T2*加权血管成像序列显示的PVS差异。依据T2*加权血管成像序列提示梗死灶周围有无PVS将入组患者分为PVS阳性组（n=27）和阴性组（n=21），分别于患者入院当日及1周后将偏侧优势组和对照组、PVS阴性和PVS阳性组利用美国国立卫生研究院脑卒中评分量表（NIHSS）进行评分，并分析评分差异。 结果48例患者中，偏侧优势组出现PVS为42.31%（11/26），对照组患者出现PVS为72.73%（16/22），对照组高于偏侧优势组（P＜0.05）；偏侧优势组及PVS阴性组患者入院当日及1周后NIHSS评分均低于对照组及PVS阳性组（P＜0.05）。 结论单侧大脑中动脉M1段闭塞后，大脑动脉偏侧优势及PVS阴性提示侧支循环建立及良好的灌注状态，并与患者近期预后密切相关。 Abstract:ObjectiveTo investigate the correlation between arterial hemidominance and prominent vessel sign (PVS) after unilateral middle cerebral artery (MCA) occlusion in M1 segment. Methods48 patients with acute ischemic stroke with unilateral MCA M1 segment occlusion from January 2018 to March 2020 were collected. Among them, there were 27 males and 21 females which the average age was 52.8±7.7 years. All patients were divided into two groups: lateral dominance group (n=26)and control group (n=22) according to the unilateral dominance of ACA and/or PCA revealed by three-dimension time of flight MRA (3D-TOF MRA). The difference of PVS shown by SWAN sequence was observed between the two groups. The patients were divided into PVS positive group(n=27) and negative group (n=21) according to SWAN sequence. On the day of admission and one week after admission, the hemidominance group and the control group, PVS negative and PVS positive groups were scored with the National Institutes of Health Stroke rating scale (NIHSS), and the differences were analyzed. ResultsAmong the 48 patients, the incidence of PVS in the unilateral dominance group was 42.31% (11/26), while that in the control group was 72.73% (16/22), the control group was significantly higher than the lateral dominant group, the difference was statistically significant (P < 0.05). The NIHSS scores of patients in the hemiplegia group and PVS negative group were lower than those in the control group and PVS positive group on the day of admission and one week later, and the difference was statistically significant. ConclusionAfter unilateral MCA M1 segment occlusion, the unilateral dominance of cerebral artery and negative PVS indicate the establishment of collateral circulation and good perfusion state, which is closely related to the short-term prognosis of the patients. -
图 1 患者女，66岁，右肢活动不利1 d，入院NIHSS评分为6分，1周后NIHSS评分为3分
A-B: 3D-TOF MRA提示左侧MCAM1段闭塞, 左侧大脑前动脉及大脑后动脉偏侧优势; C: DWI提示左侧脑室旁急性梗死灶; D-E: SWAN提示双侧软脑膜引流静脉及髓纹静脉对称显示, PVS阴性.
Figure 1. Female patient, 66 years old, the right limb movement was disadvantageous for one day. The NIHSS score was 6 when the patient was admitted to hospital and 3 after one week.
表 1 偏侧优势组与对照组PVS检出率比较(%)
Table 1. Comparison of PVS detection rate between the dominant group and the control group
组别 PVS阳性 PVS阴性 偏侧优势组（n=26） 42.31（11/26） 57.69（15/26） 对照组（n=22） 72.73（16/22 27.27（6/22） χ2 4.481 P 0.034 PVS: Prominent vessel sign. 
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表 2 偏侧优势与患者入院当日及1周NIHSS评分比较(Mean±SD)
Table 2. Comparison of the score of NIHSS on the day of admission and one week
组别 入院当日 入院1周 偏侧优势组（n=26） 5.36±2.96 3.08±1.65 对照组（n=22） 7.82±3.07 4.96±1.59 t -2.8206 -3.5735 P 0.0071 0.0008
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表 3 PVS与患者入院当日及1周NIHSS评分比较(Mean±SD)
Table 3. Comparison of NIHSS scores of PVS and patients on the day of admission and one week
组别 入院当日 入院1周 PVS阳性组（n=27） 7.68±2.76 5.66±2.41 PVS阴性组（n=21） 5.91±2.96 3.56±1.84 t 2.1416 3.3431 P 0.0376 0.0017 PVS: Prominent vessel sign.
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