Acute Symptomatic Basilar Artery Stenosis: MR Imaging Predictors of Early Neurologic Deterioration and Long-term Outcomes

作者：Lee Woo Jin; Jung Keun Hwa; Ryu Young Jin; Lee Keon Joo^*; Lee Soon Tae; Chu Kon; Lee Sang Kun; Roh Jae Kyu

来源：Radiology, 2016, 280(1): 193-201.

DOI：10.1148/radiol.2016151827

Purpose: To determine clinical, laboratory, and radiologic factors associated with early neurologic deterioration ( END) and long-term outcomes in patients with medically treated symptomatic basilar artery stenosis (BAS).
Materials and Methods: The study design was approved by the institutional review board. From a database of all consecutive patients with cerebrovascular ischemia, the authors retrospectively included 292 patients with medically treated symptomatic BAS with at least 70% stenosis of the basilar artery. The authors evaluated various clinical factors, including National Institutes of Health Stroke Scale (NIHSS) score, C-reactive protein (CRP) level, fibrinogen level, and radiologic factors, including diffusion-weighted (DW) magnetic resonance (MR) imaging-based posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS), hyperintense basilar artery at fluid-attenuated inversion recovery (FLAIR) imaging (FLAIR-hyperintense vessel [FHV]), and clot signs. The outcomes were defined as the development of END and with the 90-day modified Rankin Scale score (favorable score: 0-2). The authors performed a x(2) test, followed by logistic regression analysis, to identify independent outcome predictors.
Results: The development of END was highly correlated with unfavorable 90-day modified Rankin Scale score (P < .001). The significant predictors for END were CRP level of at least 1.5 mg/dL (P < .001), NIHSS score of at least 4 (P = .002), pc-ASPECTS of 6 or less (P,.001), and proximal FHV (P = .022). Proximal FHV (P = .010), pc-ASPECTS of 6 or less (P = .002), brainstem involvement (P = .036), and NIHSS score of at least 4 (P < .001) were associated with an unfavorable 90-day modified Rankin Scale score. Neither aggressive medical treatment nor delayed intervention was associated with a favorable 90-day modified Rankin Scale score.
Conclusion: In medically treated symptomatic BAS, MR imaging parameters such as proximal basilar FHV and DW imagingbased pc-ASPECTS have independent prognostic values for END development and long-term outcomes.

• 出版日期2016-7