Prognostic Value of Apparent Diffusion Coefficient for Mechanical Thrombectomy in Patients with Acute Posterior Ischemic Stroke.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2024-12-06 DOI:10.1016/j.wneu.2024.11.041

Xinze Guo, Xiaopan Cao, Qian Sun, Honghao Li, Yang Zhang, Yi Sui

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引用次数: 0

Abstract

Background: This study investigates the prognostic value of the apparent diffusion coefficient (ADC) in magnetic resonance imaging for patients with acute posterior circulation stroke (PCS) undergoing endovascular therapy (EVT).

Methods: A retrospective analysis was conducted of patients with acute PCS from January 2017 to December 2021, confirmed by diffusion-weighted imaging (DWI)-ADC within 24 hours of onset. Patients were categorized based on their 3-month modified Rankin Scale score after EVT. Data on the National Institutes of Health Stroke Scale at admission, ADC value, and 3-month modified Rankin Scale score were collected. Multivariable logistic regression analyzed the impact of various factors on ADC values. The receiver operating characteristic curve assessed predictive indices.

Results: Among 94 patients, 47 had a good prognosis and 47 had a poor prognosis. Univariate analysis showed that factors significantly associated with a good prognosis included lower National Institutes of Health Stroke Scale at admission, higher ADC values, smaller infarct areas, unilateral infarction, basilar artery occlusion, lower pons-midbrain-thalamus scores, intravenous thrombolysis, intra-arterial thrombolysis, and fewer perioperative complications (P < 0.05). Multivariable logistic regression identified high ADC values (P = 0.002) and unilateral infarction (P = 0.017) as independent predictive factors for prognosis. An ADC value >549 × 10^-6 mm²/second was associated with a higher rate of good prognosis. Combining ADC values with unilateral infarction resulted in the highest area under the curve and Youden Index of 0.766, with sensitivity and specificity of 89.36% and 87.23%, respectively (P < 0.05).

Conclusions: High ADC values and unilateral infarction are independent predictive factors for the prognosis of patients with PCS after EVT. Combining these factors provides the highest predictive accuracy, aiding in clinical decision making for PCS treatment.

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急性后缺血性脑卒中患者机械血栓清除术的表观弥散系数的预后价值

背景：本研究探讨了磁共振成像中表观弥散系数（ADC）对接受血管内治疗（EVT）的急性后循环卒中（PCS）患者的预后价值：对2017年1月至2021年12月期间的急性PCS患者进行了回顾性分析，这些患者在发病24小时内经弥散加权成像（DWI）-ADC证实。根据EVT后3个月的mRS评分对患者进行分类。收集了入院时的 NIHSS、ADC 值和 3 个月的 mRS 数据。多变量逻辑回归分析了各种因素对 ADC 值的影响。接受者操作特征曲线评估了预测指数：94例患者中，47例预后良好，47例预后不良。单变量分析显示，与预后良好显著相关的因素包括入院时 NIHSS 较低、ADC 值较高、梗死面积较小、单侧梗死、基底动脉闭塞、PMT 评分较低、静脉溶栓、动脉内溶栓和围手术期并发症较少（P < 0.05）。多变量逻辑回归确定高 ADC 值（p=0.002）和单侧梗死（p=0.017）是预后的独立预测因素。ADC值大于549×10- 6 mm2/s与较高的预后良好率相关。将 ADC 值与单侧脑梗死相结合，AUC 最高，尤登指数为 0.766，灵敏度和特异度分别为 89.36% 和 87.23%（p 结论：ADC 值高和单侧脑梗死对预后的影响最大：高 ADC 值和单侧梗死是 EVT 后 PCS 患者预后的独立预测因素。将这些因素结合在一起可提供最高的预测准确性，有助于PCS治疗的临床决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS