Application of carotid artery color Doppler ultrasound combined with brain MRI in patients with anterior circulation atherosclerotic cerebral infarction
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摘要:
目的 探究前循环动脉粥样硬化性脑梗死患者采用颈动脉彩超联合颅脑MRI评估病情严重程度临床价值。 方法 回顾性分析2021年1月~2021年11月医院收治50例前循环动脉粥样硬化性脑梗死患者的资料，依据美国国立卫生研究院脑卒中量表评分，将患者分别纳入轻型脑梗死组（≤7分，n=40）与重型脑梗死组（> 7分，n=10）。患者均接受颈动脉彩超及颅脑MRI检查，分析两者联合在患者病情严重程度上评估价值。 结果 重型脑梗死组患者不稳定斑块比例、狭窄率、搏动指数（PI）、阻力指数（RI）均高于轻型脑梗死组患者，峰值流速（PSV）、舒张末期流速（EDV）低于轻型脑梗死组患者（P < 0.05）；重型脑梗死组患者表面弥散系数（ADC）低于轻型脑梗死组患者（P < 0.05），两组患者T1WI信号与T2WI信号检出情况的差异无统计学意义（P > 0.05）；Spearman相关性分析显示，ADC、不稳定斑块、PI、RI、PSV、EDV与患者病情严重程度存在相关性（P < 0.05）；ROC曲线显示ADC、不稳定斑块、PI、PSV、RI、EDV用于重型脑梗死评估曲线下面积分别为0.638、0.556、0.600、0.608、0.798、0.713，各指标联合曲线下面积值为0.968。 结论 前循环动脉粥样硬化性脑梗死患者病情可以采用颈动脉彩超与颅脑MRI进行评估，两者用于患者病情严重程度评估均有一定价值。 -
关键词:
- 颈动脉彩超 /
- 颅脑MRI /
- 前循环动脉粥样硬化性脑梗死 /
- 病情严重程度
Abstract:Objective To investigate the clinical value of carotid artery color Doppler ultrasound combined with brain MRI in severity evaluation of anterior circulation atherosclerotic cerebral infarction. Methods A retrospective review was conducted on the data of 50 patients with anterior circulation atherosclerotic cerebral infarction who were admitted to the hospital between January and November. The patients were divided into the mild cerebral infarction group (n=40, NIHSS score ≤7) and the severe cerebral infarction group (n=10, NIHSS score > 7) according to the NIHSS score. All patients were examined with carotid artery color Doppler ultrasound and brain MRI. The value of combination of the two methods in severity evaluation was analyzed. Results The proportion of unstable plaques, stenosis rate, pulsatility index (PI) and resistance index (RI) in the severe cerebral infarction group were higher than those in the mild cerebral infarction group. The peak systolic velocity (PSV) and end-diastolic velocity (EDV) were lower than those in the mild cerebral infarction group (P < 0.05). The apparent diffusion coefficient (ADC) of the severe cerebral infarction group was significantly lower than that of the mild cerebral infarction group (P < 0.05). The detection of T1WI signals and T2WI signals showed no statistically significant difference between the groups (P > 0.05). Spearman correlation analysis found that ADC, unstable plaque, PI, RI, PSV, and EDV were correlated with the severity (P < 0.05). ROC curve analysis found that the AUC values of ADC, unstable plaque, PI, PSV, RI, and EDV to evaluate severe cerebral infarction were 0.638, 0.556, 0.600, 0.608, 0.798 and 0.713, respectively. The AUC of joint evaluation with these indicators was 0.968. Conclusion Carotid artery color Doppler ultrasound and brain MRI both can be used for severity evaluation of patients with anterior circulation atherosclerotic cerebral infarction. -
图 1 MRI测定指标、彩色超声参数对重型脑梗死评估价值分析ROC曲线
Figure 1. ROC curves of MRI measurements and color Doppler ultrasound parameters for evaluating severe cerebral infarction.
表 1 两组患者彩色超声参数比较
Table 1. Comparison of color Doppler ultrasound parameters between the two groups (Mean±SD)
组别 不稳定斑块[n(%)] PI PSV（cm/s） RI EDV（cm/s） 轻型脑梗死组（n=40） 4（10.00） 1.08±0.32 62.53±10.29 1.12±0.21 25.34±3.51 重型脑梗死组（n=10） 5（50.00） 1.36±0.45 54.58±9.24 1.34±0.25 23.49±4.08 t/χ2 6.174 2.275 2.198 3.372 2.225 P 0.013 0.027 0.033 ＜0.001 0.031 PI: 搏动指数; PSV峰值流速; RI: 阻力指数; EDV: 舒张末期流速. 
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表 2 两组MRI测定指标比较
Table 2. Comparison of MRI measurements between the two groups [n(%)]
组别 ADC值（μm2/ms, Mean±SD） T1WI信号 T2WI信号 等信号 低信号 等信号 高信号 轻型脑梗死组（n=40） 0.59±0.16 32（80.00） 8（20.00） 10（25.00） 30（75.00） 重型脑梗死组（n=10） 0.50±0.15 8（80.00） 2（20.00） 4（40.00） 6（60.00） t/χ2 3.675 0.195 0.304 P 0.001 0.659 0.581
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表 3 MRI测定指标、彩色超声参数与患者病情严重程度相关性分析
Table 3. Correlation analysis of MRI measurements, color Doppler ultrasound parameters and the patients' condition
参数 r P ADC值 -0.379 0.003 不稳定斑块 0.282 0.030 PI 0.424 0.001 PSV -0.309 0.017 RI 0.552 ＜0.001 EDV -0.422 0.001
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表 4 MRI测定指标、彩色超声参数对重型脑梗死评估价值分析
Table 4. Value of MRI measurements and color Doppler ultrasound parameters in evaluating severe cerebral infarction
指标 曲线下面积 敏感度（%） 特异性（%） 95% CI P ADC 0.638 90.0 42.5 0.467~0.808 0.182 不稳定斑块 0.556 50.0 70.0 0.367~0.745 0.585 PI 0.600 50.0 82.5 0.368~0.832 0.332 PSV 0.608 80.0 47.5 0.436~0.779 0.297 RI 0.798 80.0 72.5 0.647~0.948 0.004 EDV 0.713 60.0 82.5 0.544~0.881 0.039 各指标联合 0.968 100.0 90.0 0.923~1.000 ＜0.001
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