Predictive value of QSM combined with SWI in neurological function of patients with acute ischemic stroke after endovascular treatment

doi:10.11817/j.issn.1673-9248.2024.06.005

Abstract

Abstract:

Objective

To explore the predictive value of quantitative susceptibility mapping（QSM） combined with susceptibility weighted imaging （SWI） for neurological function in patients with acute ischemic stroke （AIS） after endovascular treatment （EVT）.

Methods

One hundred and sixty nine AIS patients admitted to our hospital from February 2020 to October 2023 were included.Demographic data and imaging examination results of patients were collected at admission.All patients undewent EVT and were followed up for 3 months after treatment.Patients were categorized into two groups based on the modified Rankin Scale （mRS） score： good neurological function group （mRS ≤2） and poor neurological function group （mRS＞2）.Multivariate Logistic regression was used to analyze the factors influencing patients'neurological function， and receiver operating characteristic （ROC） curve was drawn to evaluate the predictive value of QSM combined with SWI on neurological function.

Results

A total of 156 patients were included，comprising 99 patients with good prognosis and 57 with poor prognosis.The NIHSS score was significantly higher in patients with good neurological function compared to those with poor neurological function （P＜0.05）.The coefficient of variation （CV）， median， maximum， and minimum value of QSM were higher in patients with good neurological function， with the average value also being higher than in those with poor neurological function.Lesion volume， the diameter of magnetic sensitive vessel sign （SVS）， and the SVS positivity were lower than those in patients with poor neurological function （P＜0.05）.There was no significant difference in skewness， kurtosis and standard deviation between the two groups （P＞0.05）.In multivariate Logistic analysis，with mRS score as the dependent variable （1=good， 0=bad）， the CV （OR=3.574， 95%CI： 1.228-10.400）， median（OR=0.018， 95%CI： 0.001-0.621）， lesion volume （OR=1.125， 95%CI： 1.024-1.235）， SVS positivity （OR=55.304，95%CI： 1.609-1900.426）， and SVS diameter （OR=1.287， 95%CI： 1.032-1.604） were all predictive factors for postoperative neurological function （P＜0.05）； ROC curve showed that the area under curve （AUC） for SVS positivity， SVS diameter， CV， lesion volume， and median on postoperative neurological function were 0.616，0.836， 0.859， 0.803， and 0.867， respectively， and the AUC of QSM combined with SWI （0.985） was higher than that of individual parameters （0.935 and 0.912， P＜0.05）.

Conclusion

The CV， median of QSM parameters，SVS positivity and diamete of SWI parameters， and lesion volume are all Influential factors affecting postoperative neurological function， with high predictive value.The combination of QSM with SWI offers superior predictive value for neurological function following EVT in patients with AIS.

Key words: Quantitative susceptibility mapping, Susceptibility weighted imaging, Acute ischemic stroke, Endovascular therapy, Neurological function, Predicted value

Xiaoyong Li, Haizhi Guo, Yang Zhao. Predictive value of QSM combined with SWI in neurological function of patients with acute ischemic stroke after endovascular treatment[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2024, 18(06): 549-555.

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Figures/Tables 6

临床资料	神经功能良好组（99例）	神经功能不良组（57例）	统计值	P值
年龄（岁， $\overset{ˉ}{x}$ ±s）	65.57±12.22	61.35±15.60	t=1.176	0.082
性别［例（%）］			χ²=0.017	0.897
男	58（58.58）	34（59.65）
女	41（41.42）	23（40.35）
BMI（kg/m²， $\overset{ˉ}{x}$ ±s）	24.42±2.43	24.76±2.79	t=0.768	0.444
伴随疾病［例（%）］
高血压	57（57.57）	34（59.65）	χ²=0.064	0.800
高脂血症	42（42.42）	21（36.84）	χ²=0.468	0.494
糖尿病	26（26.26）	12（21.05）	χ²=0.533	0.465
卒中病因［例（%）］			χ²=0.918	0.632
心源性栓塞	15（15.15）	7（12.28）
大动脉粥样硬化	80（80.81）	49（85.96）
其他	4（4.04）	1（1.76）
起病至MRI检查时间（h， $\overset{ˉ}{x}$ ±s）	38.76±10.36	40.36±12.36	t=0.825	0.412
血管狭窄位置［例（%）］			χ²=0.423	0.809
颈内动脉颅内段	18（18.18）	9（15.79）
大脑中动脉近端	66（66.67）	41（71.93）
大脑中动脉远端	15（15.15）	7（12.28）
梗死侧别［例（%）］			χ²=0.656	0.418
右侧	57（57.58）	29（50.88）
左侧	42（42.42）	28（49.12）
入院NIHSS评分（分， $\overset{ˉ}{x}$ ±s）	12.67±4.74	15.34±4.14	t=3.545	0.001
发病至动脉取栓时间（h，x±s）	35.47±12.74	38.98±14.87	t=1.494	0.138

临床资料	神经功能良好组（99例）	神经功能不良组（57例）	统计值	P值
年龄（岁， $\overset{ˉ}{x}$ ±s）	65.57±12.22	61.35±15.60	t=1.176	0.082
性别［例（%）］			χ²=0.017	0.897
男	58（58.58）	34（59.65）
女	41（41.42）	23（40.35）
BMI（kg/m²， $\overset{ˉ}{x}$ ±s）	24.42±2.43	24.76±2.79	t=0.768	0.444
伴随疾病［例（%）］
高血压	57（57.57）	34（59.65）	χ²=0.064	0.800
高脂血症	42（42.42）	21（36.84）	χ²=0.468	0.494
糖尿病	26（26.26）	12（21.05）	χ²=0.533	0.465
卒中病因［例（%）］			χ²=0.918	0.632
心源性栓塞	15（15.15）	7（12.28）
大动脉粥样硬化	80（80.81）	49（85.96）
其他	4（4.04）	1（1.76）
起病至MRI检查时间（h， $\overset{ˉ}{x}$ ±s）	38.76±10.36	40.36±12.36	t=0.825	0.412
血管狭窄位置［例（%）］			χ²=0.423	0.809
颈内动脉颅内段	18（18.18）	9（15.79）
大脑中动脉近端	66（66.67）	41（71.93）
大脑中动脉远端	15（15.15）	7（12.28）
梗死侧别［例（%）］			χ²=0.656	0.418
右侧	57（57.58）	29（50.88）
左侧	42（42.42）	28（49.12）
入院NIHSS评分（分， $\overset{ˉ}{x}$ ±s）	12.67±4.74	15.34±4.14	t=3.545	0.001
发病至动脉取栓时间（h，x±s）	35.47±12.74	38.98±14.87	t=1.494	0.138

参数	神经功能良好组（99例）	神经功能不良组（57例）	统计值	P值
QSM参数
平均值（×10⁶）	0.33±0.07	0.22±0.09	t=7.947	＜0.001
中位数（×10⁶）	0.32±0.07	0.21±0.08	t=8.648	＜0.001
标准差（×10⁶）	0.11±0.03	0.10±0.04	t=1.640	0.104
最大值（×10⁶）	0.64±0.17	0.53±0.18	t=3.750	＜0.001
最小值（×10⁶）	0.11±0.03	0.04±0.01	t=21.256	＜0.001
偏度	0.39±0.17	0.41±0.21	t=0.613	0.542
峰度	2.69±0.36	2.72±0.40	t=0.468	0.641
CV（×10⁶）	0.34±0.12	0.51±0.14	t=7.685	＜0.001
SWI参数
病灶体积（mm³）	70.52±25.37	103.34±30.25	t=6.911	＜0.001
SVS阳性［例（%）］	24（24.24）	27（47.37）	χ²=8.792	0.003
SVS直径（mm）	12.34±4.36	21.85±8.66	t=7.745	＜0.001

指标	β值	SE值	Wald值	P值	OR值	95%CI
指标	β值	SE值	Wald值	P值	OR值	下限	上限
NIHSS评分	-0.805	0.507	2.516	0.113	0.447	0.166	1.209
平均值	-0.782	0.699	1.251	0.263	0.457	0.116	1.801
中位数	-4.013	1.805	4.945	0.026	0.018	0.001	0.621
最大值	-3.598	13.702	0.069	0.793	0.027	0.000	1.261×10¹⁰
最小值	-290.765	242.449	1.438	0.230	0.000	0.000	1.247×10⁸⁰
CV	1.274	0.545	5.464	0.019	3.574	1.228	10.400
病灶体积	0.117	0.048	6.000	0.014	1.125	1.024	1.235
SVS阳性	4.013	1.805	4.945	0.026	55.304	1.609	1900.426
SVS直径	0.252	0.112	5.024	0.025	1.287	1.032	1.604

参数	曲线下面积	SE值	敏感度（%）	特异度（%）	95%CI
参数	曲线下面积	SE值	敏感度（%）	特异度（%）	下限	上限
中位数	0.867	0.030	85.90	73.70	0.803	0.916
CV	0.859	0.030	66.70	91.20	0.794	0.909
病灶体积	0.803	0.037	72.70	78.90	0.732	0.862
SVS阳性	0.616	0.0477	75.80	47.40	0.534	0.692
SVS直径	0.836	0.0385	91.90	71.90	0.769	0.891
QSM	0.935	0.019	91.90	86.00	0.885	0.968
SWI	0.912	0.025	88.90	82.50	0.856	0.951
联合	0.985	0.006	94.90	94.70	0.952	0.998

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