侧支循环在FLAIR信号强度比值与急性脑卒中发病时间关系的中介效应分析-现代医学

侧支循环在FLAIR信号强度比值与急性脑卒中发病时间关系的中介效应分析

单位：1. 南京市高淳人民医院放射科, 江苏南京 211300;
2. 南京医科大学附属南京医院, 南京市第一医院医学影像科, 江苏南京 210006

分类号：R445.2

出版年·卷·期（页码）：2024·52·第十期（1485-1489）

摘要：

目的： 探讨侧支循环在液体衰减反转恢复序列(FLAIR)信号强度比值(SIR)与急性脑卒中发病时间中的作用价值。方法： 回顾性分析南京医科大学附属南京医院发病时间明确的急性脑卒中患者120例，侧支循环评分采用磁共振血管造影(MRA)评估。应用中介效应分析方法分析侧支循环在FLAIR SIR与发病时间之间的关系。应用Spearman等级相关分析及受试者工作特征(ROC)曲线分析FLAIR SIR在急性脑卒中发病时间中的预测价值。结果： Spearman等级相关分析显示在侧支循环不良组，FLAIR SIR与发病时间呈正相关(r=0.415,P<0.001)，而在侧支循环良好组，FLAIR SIR与发病时间无明显相关性(r=0.198,P=0.152)。中介效应分析显示，侧支循环在FLAIR SIR 与发病时间之间起部分中介作用，中介效应占总效应的比例为31.85%。ROC分析显示，FLAIR SIR预测急性脑卒中患者发病时间的曲线下面积(AUC)为0.870，明显优于弥散加权成像(DWI)-FLAIR不匹配的预测效能(AUC=0.645；Z=3.290；P=0.001)。结论： 侧支循环部分介导FLAIR SIR与急性脑卒中发病时间之间的关系，FLAIR SIR在侧支循环不良的患者中可更为准确地预测急性脑卒中发病时间。

Objective: To investigate the role of collateral circulation in the relationship between the fluid-attenuated inversion recovery(FLAIR) signal intensity ratio(SIR) and time from stroke onset. Methods: A total of 120 patients with acute stroke and clear oneset times from Nanjing First Hospital, Nanjing Medical University were analyzed retrospectively. Magnetic resonance angiography(MRA) was used to evaluate the collateral circulation. Mediation analysis was used to analyze the association between FLAIR SIR and time from stroke onset. Spearman rank correlation and receiver operating characteristic(ROC) curve analysis were performed to evaluate the predictive value of FLAIR SIR in the time from stroke onset. Results: Spearman correlation analysis showed that the FLAIR SIR was significant positive correlation with time from stroke onset in the poor collateral circulation group(r=0.415, P<0.001), while there was no significant correlation between FLAIR SIR and time from stroke onset(r=0.198, P=0.152) in the good collateral circulation group. Mediation analysis indicated that the relationship between FLAIR SIR and time from stroke onset was partially mediated by collateral circulation, accounting for 31.85% of the total effect. ROC analysis demonstrated that the area under the curve(AUC) of FLAIR SIR in predicting the time from stroke onset was 0.870, which was significantly better than the predictive performance of diffusion weighted imaging(DWI)-FLAIR mismatch(AUC=0.645;Z=3.290; P=0.001). Conclusion: The collateral circulation partially mediates the relationship between FLAIR SIR and the time from stroke onset. FLAIR SIR can more accurately predict the time from stroke onset, particularly in patients with poor collateral circulation.

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