Value of amide proton chemical exchange saturation transfer MRI in predicting the prognosis of neurological function in cerebral infarction
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摘要:
目的分析氨基质子化学交换饱和磁共振成像预测脑梗死神经功能预后的价值。 方法选择2017年7月~2019年7月我院收治的138例脑梗死患者，根据其入院3月后的改良Rankin量表评分（mRS）分为预后良好组（mRS < 2分，n=84）与预后不良组（mRS≥2分，n=54），两组均行氨基质子化学交换饱和磁共振成像检查，对两组氨基质子加权信号值（APTw）进行定量分析比较，分析ΔAPTw值、APTwmax-min值与脑梗死神经功能预后的关系，分析∆APTw值、APTwmax-min值对脑梗死神经功能预后的预测价值。 结果预后不良组∆APTw值低于预后良好组（P < 0.05）；预后不良组APTwmax-min值高于预后良好组（P < 0.05）；∆APTw值与脑梗死神经功能预后呈正相关（P < 0.05）；APTwmax-min值与脑梗死神经功能预后呈负相关（P < 0.05）；∆APTw值减小、APTwmax-min值增加是脑梗死神经功能预后不良的危险因素（P < 0.05）；∆APTw值联合APTwmax-min值预测脑梗死神经功能预后的AUC为0.832，敏感度为75.91%，特异性为83.32%，准确度为88.32%，∆APTw值的临界值为-0.92，APTwmax-min值的临界值为0.75。 结论氨基质子化学交换饱和磁共振成像中APTw的定量分析能够较好的预测脑梗死神经功能预后，在脑梗死患者氨基质子化学交换饱和磁共振成像检查过程中若发现∆APTw值减小、APTwmax-min值增加，临床应及时采取干预措施，改善其预后。 -
关键词:
- 氨基质子化学交换饱和磁共振成像 /
- 脑梗死 /
- 预后 /
- 相关性 /
- 预测价值
Abstract:ObjectiveTo investigate value of amide proton chemical exchange saturation transfer MRI in predicting the prognosis of neurological function in cerebral infarction. MethodsA total of 138 patients with cerebral infarction in our hospital from July 2017 to July 2019 were enrolled. Based on modified Rankin scale score (mRS) at post-admission 3 months, they were divided into two groups: good prognosis group (n=84, mRS < 2) and poor prognosis group (n=54, mRS≥2). All patients received amide proton chemical exchange saturation transfer MRI examinations. The amide proton transfer-weighted (APTw) signal intensity was quantitatively analyzed in both groups. The correlation of ∆APTw value and APTwmax-min value with neurological function prognosis of cerebral infarction was analyzed, and the predictive value of two indicators on neurological function prognosis was also verified. ResultsThe ∆APTw value of poor prognosis group was lower than that of good prognosis group (P < 0.05). APTwmax-min value of poor prognosis group was higher than that of good prognosis group (P < 0.05). ∆APTw value was positively correlated with prognosis of cerebral infarction neurological function (P < 0.05). APTwmax-min value was negatively correlated with neurological function prognosis of cerebral infarction (P < 0.05). Decrease in ∆APTw value and increase in APTwmax-min value were risk factors for poor neurological prognosis of cerebral infarction (P < 0.05). The AUC, sensitivity, specificity and accuracy of ∆APTw value combined with APTwmax-min in predicting the neurological prognosis of cerebral infarction were 0.832, 75.91%, 83.32%, and 88.32%, respectively. The critical values of ∆APTw and APTwmax-min were-0.92 and 0.75, respectively. ConclusionQuantitative analysis of APTW in amide proton chemical exchange saturation transfer MRI has high value in predicting the neurological function prognosis of cerebral infarction, moreover, clinical intervention measures are of vital importance when there is a decrease in ∆APTw value and increase in APTwmax-min value. -
图 1 ∆APTw值、APTwmax-min值与脑梗死神经功能预后的相关性
Figure 1. The correlation between the value of ∆APTw and APTwmax-min and prognosis of cerebral infarction.
图 2 ∆APTw值联合APTwmax-min值预测脑梗死神经功能预后的ROC曲线
Figure 2. ROC curve for predicting neurological function prognosis of cerebral infarction with ∆APTw value combined with APTwmax-min value.
图 3 T1WI、T2WI、DWI、APTw图像
A: 65岁男性患者，入院3月后的mRS评分为0，∆APTW值为-0.38%，APTwmax-min值为0.41%；B: 62岁女性患者，入院3月后的mRS评分为2，∆APTW值为-0.80%，APTwmax-min值为0.86%；C: 73岁男性患者，入院3月后的mRS评分为6，∆APTw值为-1.88%，APTwmax-min值为1.27%.
Figure 3. The images of T1WI, T2WI, DWI and APTw.
表 1 两组∆APTW值、APTwmax-min值比较
Table 1. Comparison of ∆APTw and APTwmax-min between the two groups (%, Mean±SD)
组别 ∆APTW值 APTwmax-min值 预后良好组（n=84） -0.59±0.47 0.62±0.11 预后不良组（n=54） -1.48±0.69 1.05±0.29 t 8.319 -10.425 P < 0.001 < 0.001 
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表 2 脑梗死神经功能预后的影响因素分析
Table 2. Analysis of influencing factors of neurological function prognosis in cerebral infarction
变量 P 相对危险度 95%CI 年龄 0.592 1.251 0.551~2.841 性别 0.230 0.671 0.349~1.288 BMI 0.167 1.590 0.823~3.071 合并糖尿病 0.550 1.234 0.620~2.453 合并高血压 0.330 1.439 0.692~2.995 合并高血脂 0.248 0.987 0.965~1.009 合并心脏病 0.368 1.616 0.569~4.588 吸烟史 0.350 1.072 0.927~1.240 饮酒史 0.755 1.017 0.914~1.132 ∆APTw值减小 < 0.001 2.927 1.347~5.288 APTwmax-min值 0.008 2.319 1.319~4.629
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