医学影像学杂志

目的 探讨高分辨率血管壁成像（HR-VWI）参数对急性缺血性脑卒中（AIS）患者早期神经功能损伤及复发风险的预测价值。方法 选取AIS患者100例，发病72 h内行HR-VWI检查，获取HR-VWI参数[斑块总厚度、斑块负荷、斑块强化率、斑块内出血、斑块钙化体积、脂质核体积及重构指数（RI）]，收集患者临床资料（年龄、性别、BMI、基础疾病、吸烟饮酒史、血脂、血糖、同型半胱氨酸、尿酸）。根据美国国立卫生研究院卒中量表（NIHSS）评分，按神经功能损伤程度将患者分为轻度组（≤7分，45例）、中度组（8～14分，32例）、重度组（≥15分，23例）；同时依据Essen卒中风险评分量表（ESRS）评分，将患者分为低风险复发组（≤2分，58例）和高风险复发组（≥3分，42例）。比较不同复发风险组HR-VWI参数差异，比较不同神经功能损伤组间HR-VWI参数差异；通过多因素Logistic回归分析筛选AIS患者早期神经功能损伤及复发风险的独立预测因子。绘制ROC曲线，评估HR-VWI参数对AIS患者早期神经功能损伤及复发风险的预测效能。结果 重度组斑块总厚度、斑块负荷、斑块强化率、斑块内出血、斑块钙化体积、脂质核体积高于中度组及轻度组，RI低于中度组及轻度组（P均<0.001）。高风险复发组的斑块总厚度、斑块负荷、斑块强化率、斑块内出血、斑块钙化体积、脂质核体积高于低风险复发组，RI低于低风险复发组（P均<0.001）。多因素Logistic回归分析显示，斑块总厚度、斑块负荷、斑块强化率、RI既是AIS患者早期神经功能损伤的独立危险因素，也是其复发风险的独立危险因素（P均<0.001）。ROC曲线分析显示，斑块总厚度、斑块负荷、斑块强化率、RI评估AIS患者早期神经功能损伤程度的AUC分别为0.821、0.813、0.821、0.891，评估AIS患者复发风险的AUC分别为0.806、0.788、0.820、0.856。结论 HR-VWI检查可准确评估AIS患者的斑块特征，对患者早期神经功能损伤程度及复发风险具有良好的预测价值，可为临床制定个体化干预方案、改善患者预后提供重要依据。

Objective To investigate the clinical value of high-resolution vessel wall imaging(HR-VWI) parameters in predicting early neurological impairment and recurrence risk in patients with acute ischemic stroke(AIS). Methods A total of 100 AIS patients underwent HR-VWI within 72 hours of symptom onset. HR-VWI parameters included total plaque thickness, plaque burden, plaque enhancement ratio, intraplaque hemorrhage, calcified plaque volume, lipid core volume, and remodeling index(RI). Clinical data, in terms of age, sex, BMI, comorbidities, smoking/alcohol history, lipid profile, glucose, homocysteine, and uric acid, were collected. Based on the NIHSS score, patients were divided into mild （≤7, n=45）, moderate(8–14, n=32), and severe （≥15, n=23） neurological impairment groups. Based on the Essen Stroke Risk Score(ESRS), they were categorized into low-risk （≤2, n=58） and high-risk （≥3, n=42） recurrence groups. HR-VWI parameters were compared between groups. Multivariate Logistic regression was used to identify independent predictors, and ROC curves was employed to assess predictive performance. Results The severe group had significantly higher total plaque thickness, plaque burden, plaque enhancement ratio, intraplaque hemorrhage, calcified plaque volume, and lipid core volume, but lower RI, compared with the moderate and mild groups(all P < 0.001). Similar differences were observed between the high-and low-risk recurrence groups(all P < 0.001). Multivariate Logistic regression showed that total plaque thickness, plaque burden, plaque enhancement ratio, and RI were independent risk factors for both early neurological impairment and recurrence risk(all P < 0.001). For predicting early neurological impairment, the AUC was 0.821, 0.813, 0.821, and 0.891, respectively; for predicting recurrence risk, the AUC was 0.806, 0.788, 0.820, and 0.856, respectively. Conclusion HR-VWI accurately characterizes plaque features in AIS patients and shows good predictive value for early neurological impairment and recurrence risk, thereby providing important evidence for individualized treatment and prognosis improvement.