<br>深髓静脉损伤与小血管闭塞急性缺血性卒中中的小血管疾病相关,European Radiology

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深髓静脉损伤与小血管闭塞急性缺血性卒中中的小血管疾病相关
European Radiology ( IF 4.7 ) Pub Date : 2024-02-10 , DOI: 10.1007/s00330-024-10628-4
Xueyang Wang _{1,

2} , Jinhao Lyu ₁ , Qi Duan ₁ , Chenxi Li ₁ , Jiayu Huang ₁ , Zhihua Meng ₃ , Xiaoyan Wu ₄ , Wen Chen ₅ , Guohua Wang ₆ , Qingliang Niu ₇ , Xin Li ₈ , Yitong Bian ₉ , Dan Han ₁₀ , Weiting Guo ₁₁ , Shuai Yang ₁₂ , Xiangbing Bian ₁ , Yina Lan ₁ , Liuxian Wang ₁ , Tingyang Zhang ₁ , Caohui Duan ₁ , Xin Lou ₁ ,

Affiliation

Department of Radiology, Chinese PLA General Hospital, Beijing, China.
Department of Radiology, Yancheng Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine/ Yancheng Traditional Chinese Medicine Hospital, Jiangsu, China.
Department of Radiology, Yuebei People's Hospital, Guangdong, China.
Department of Radiology, Anshan Changda Hospital, Liaoning, China.
Department of Radiology, Shiyan Taihe Hospital, Hubei, China.
Department of Radiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Shandong, China.
Department of Radiology, WeiFang Traditional Chinese Hospital, Shandong, China.
Department of Radiology, Jilin University Second Hospital, Shandong, China.
Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China.
Department of Radiology, Kunming Medical University First Affiliated Hospital, Yunnan, China.
Department of Radiology, Shanxi Provincial People's Hospital, Shanxi, China.
Department of Radiology, Xiangya Hospital Central South University, Hunan, China.

目标

我们的目的是研究脑小血管疾病 (cSVD) 成像标志物是否与小血管闭塞急性缺血性卒中 (SVO-AIS) 患者的深部髓静脉 (DMV) 损伤相关。

方法

DMV 根据区域解剖结构分为六段。 DMV 总分 (0-18) 是根据节段连续性和可见性计算的。 DMV 损伤根据 DMV 总分的四分位数进行分组。确定了 cSVD 的神经影像生物标志物，包括白质高信号 (WMH)、脑微出血 (CMB)、血管周围间隙 (PVS) 和腔隙。进一步分析cSVD评分。

结果

我们纳入了 229 名 SVO-AIS 患者，平均年龄为 63.7 ± 23.1 岁，中位 NIHSS 评分为 3（IQR，2-6）。在重度 DMV 负担组（第四个四分位数）中，NIHSS 评分等级 (6 (3-9)) 显着高于其他组 ( p < 0.01)。基底节 PVS (BG-PVS) 的评分与 DMV 程度呈正相关 ( R = 0.67, p < 0.01)，而不是中心半叶 PVS (CS-PVS) ( R = 0.17, p = 0.1) 。在多变量分析中，高 CMB 负担（调整后优势比 [aOR]，25.38；95% 置信区间 [CI]，1.87–345.23）与严重的 DMV 评分相关。此外，BG-PVS与严重DMV负担呈剂量依赖性相关：当BG-PVS评分为3和4时，严重DMV负担的aOR分别为18.5和12.19。

结论

DMV 损伤与 cSVD 的严重程度相关，这表明 DMV 负荷可用于 SVO-AIS 患者的风险分层。

临床相关性声明

DMV 损伤评分基于小血管疾病与深髓静脉损伤之间的关联，是预测小血管闭塞急性缺血性卒中预后的潜在新影像生物标志物，具有临床管理意义。

要点

• 深髓静脉损伤可能是脑小血管疾病的机制之一。

• 基底节血管周围间隙的严重负担和脑微出血与深髓静脉的显着损伤密切相关。

• 深髓静脉损伤评分可能反映小血管闭塞急性缺血性中风患者血管损伤增加的风险。

"点击查看英文标题和摘要"

Deep medullary vein damage correlates with small vessel disease in small vessel occlusion acute ischemic stroke

Objectives

We aim to investigate whether cerebral small vessel disease (cSVD) imaging markers correlate with deep medullary vein (DMV) damage in small vessel occlusion acute ischemic stroke (SVO-AIS) patients.

Methods

The DMV was divided into six segments according to the regional anatomy. The total DMV score (0–18) was calculated based on segmental continuity and visibility. The damage of DMV was grouped according to the quartiles of the total DMV score. Neuroimaging biomarkers of cSVD including white matter hyperintensity (WMH), cerebral microbleed (CMB), perivascular space (PVS), and lacune were identified. The cSVD score were further analyzed.

Results

We included 229 SVO-AIS patients, the mean age was 63.7 ± 23.1 years, the median NIHSS score was 3 (IQR, 2–6). In the severe DMV burden group (the 4th quartile), the NIHSS score grade (6 (3–9)) was significantly higher than other groups (p < 0.01). The grade scores for basal ganglia PVS (BG-PVS) were positively correlated with the degree of DMV (R = 0.67, p < 0.01), rather than centrum semivole PVS (CS-PVS) (R = 0.17, p = 0.1). In multivariate analysis, high CMB burden (adjusted odds ratio [aOR], 25.38; 95% confidence interval [CI], 1.87–345.23) was associated with severe DMV scores. In addition, BG-PVS was related to severe DMV burden in a dose-dependent manner: when BG-PVS score was 3 and 4, the aORs of severe DMV burden were 18.5 and 12.19, respectively.

Conclusion

The DMV impairment was associated with the severity of cSVD, which suggests that DMV burden may be used for risk stratification in SVO-AIS patients.

Clinical relevance statement

The DMV damage score, based on the association between small vessel disease and the deep medullary veins impairment, is a potential new imaging biomarker for the prognosis of small vessel occlusion acute ischemic stroke, with clinical management implications.

Key Points

• The damage to the deep medullary vein may be one mechanism of cerebral small vessel disease.

• Severe burden of the basal ganglia perivascular space and cerebral microbleed is closely associated with significant impairment to the deep medullary vein.

• The deep medullary vein damage score may reflect a risk of added vascular damage in small vessel occlusion acute ischemic stroke patients.

更新日期：2024-02-10

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