Diagnostic value of diffusion tensor imaging combined with serum Hcy in patients with ischemic stroke complicated with carotid plaque

doi:10.3877/cma.j.issn.2095-9141.2024.06.008

Abstract

Abstract:

Objective

To investigate the diagnostic value of diffusion tensor imaging combined with homocysteine （Hcy） in patients with ischemic stroke complicated with carotid plaque.

Methods

A total of 142 patients with ischemic stroke admitted to Imaging Center of Hefei First People's Hospital from January 2021 to June 2022 were retrospectively selected as the study objects， and were divided into carotid plaque group and no carotid plaque group according to whether they had carotid plaque. The patients were examined by diffusion tensor imaging （DTI） using MRI scanner， the homocysteine level was detected by enzyme circulation method，and the diagnostic efficacy of diffusion tensor imaging parameters［fractional anisotropy （FA） and mean diffusivity （MD）］ and Hcy levels for ischemic stroke complicated with carotid plaques was analyzed by receiver operating characteristic （ROC） curve.

Results

Among 142 patients with ischemic stroke， there were 75 cases in no carotid plaque group and 67 cases carotid plaque group.Compared with no carotid plaque group，the DTI parameters of FA and MD in patients with carotid plaques were reduced， and the serum Hcy level was increased， with statistical significance （P＜0.05）. Logistic regression analysis showed that FA， MD， and Hcy were all risk factors for ischemic stroke complicated with carotid plaques （P＜0.05）. ROC curve analysis showed that the area under the curve（AUC） of FA， MD， and Hcy for the diagnosis of stroke complicated with carotid plaques were 0.830，0.820，and 0.841，respectively.The AUC of the combined detection of FA，MD，and Hcy was 0.909，which was higher than the single detection of FA， MD， and Hcy.

Conclusion

Magnetic resonance diffusion imaging DTI parameters combined with Hcy testing can improve the diagnostic efficiency of patients with ischemic stroke complicated with carotid plaque.

Key words: Ischemic stroke, Carotid plaque, Diffusion tensor imaging, Homocysteine

Qian Zhou, Chunhua Xia, Bing Chen. Diagnostic value of diffusion tensor imaging combined with serum Hcy in patients with ischemic stroke complicated with carotid plaque[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2024, 10(06): 367-372.

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Figures/Tables 5

Tab.1 Comparison of general data between two groups

项目	无颈动脉斑块组（n=75）	颈动脉斑块组（n=67）	χ²/t/U值	P值
性别［例（%）］			0.236	0.627
男	40（53.33）	33（49.25）
女	35（46.67）	34（50.75）
年龄（岁， $\overset{ˉ}{x}$ ±s）	62.25±8.08	63.30±8.58	0.751	0.454
体质量指数（kg/m²， $\overset{ˉ}{x}$ ±s）	23.15±1.50	22.89±1.74	0.956	0.341
梗死位置［例（%）］			0.095	0.758
左侧	40（53.33）	34（50.75）
右侧	35（46.67）	33（49.25）
家族遗传史［例（%）］	7（9.33）	5（7.46）	0.160	0.689
受教育年限（年， $\overset{ˉ}{x}$ ±s）	10.24±3.55	10.12±3.61	0.200	0.842
合并基础疾病［例（%）］
高胆固醇血症	5（6.67）	7（10.45）	0.654	0.419
糖尿病	26（34.67）	21（31.34）	0.177	0.674
高血压	49（65.33）	48（71.64）	0.651	0.420
冠心病	12（16.00）	10（14.93）	0.031	0.860
吸烟史	34（45.33）	30（44.78）	0.004	0.947
饮酒史	23（30.67）	18（26.87）	0.249	0.618
NIHSS评分［分，M（P₂₅，P₇₅）］	27.00（26.00，29.00）	28.00（26.00，31.00）	0.258	0.790
mRs评分［分，M（P₂₅，P₇₅）］	2.00（1.00，3.00）	3.00（2.00，1.00）	0.418	0.497
ADL评分［分，M（P₂₅，P₇₅）］	65.00（63.00，68.00）	64.00（62.00，66.00）	0.606	0.375
WML评分（分， $\overset{ˉ}{x}$ ±s）	1.50±0.39	1.46±0.31	0.671	0.503

Tab.1 Comparison of general data between two groups

项目	无颈动脉斑块组（n=75）	颈动脉斑块组（n=67）	χ²/t/U值	P值
性别［例（%）］			0.236	0.627
男	40（53.33）	33（49.25）
女	35（46.67）	34（50.75）
年龄（岁， $\overset{ˉ}{x}$ ±s）	62.25±8.08	63.30±8.58	0.751	0.454
体质量指数（kg/m²， $\overset{ˉ}{x}$ ±s）	23.15±1.50	22.89±1.74	0.956	0.341
梗死位置［例（%）］			0.095	0.758
左侧	40（53.33）	34（50.75）
右侧	35（46.67）	33（49.25）
家族遗传史［例（%）］	7（9.33）	5（7.46）	0.160	0.689
受教育年限（年， $\overset{ˉ}{x}$ ±s）	10.24±3.55	10.12±3.61	0.200	0.842
合并基础疾病［例（%）］
高胆固醇血症	5（6.67）	7（10.45）	0.654	0.419
糖尿病	26（34.67）	21（31.34）	0.177	0.674
高血压	49（65.33）	48（71.64）	0.651	0.420
冠心病	12（16.00）	10（14.93）	0.031	0.860
吸烟史	34（45.33）	30（44.78）	0.004	0.947
饮酒史	23（30.67）	18（26.87）	0.249	0.618
NIHSS评分［分，M（P₂₅，P₇₅）］	27.00（26.00，29.00）	28.00（26.00，31.00）	0.258	0.790
mRs评分［分，M（P₂₅，P₇₅）］	2.00（1.00，3.00）	3.00（2.00，1.00）	0.418	0.497
ADL评分［分，M（P₂₅，P₇₅）］	65.00（63.00，68.00）	64.00（62.00，66.00）	0.606	0.375
WML评分（分， $\overset{ˉ}{x}$ ±s）	1.50±0.39	1.46±0.31	0.671	0.503

Tab.2 Comparison of DTI parameters between two groups

组别	例数	FA	MD
无颈动脉斑块组	75	0.54±0.09	4.18±1.02
颈动脉斑块组	67	0.44±0.07	3.52±0.90
t值		7.327	4.067
P值		＜0.001	0.001

Tab.3 Logistic regression analysis of risk factors for ischemic stroke complicated with carotid plaque

相关因素	偏回归系数	标准误	Wald χ²值	OR值	95%CI	P值
FA	0.505	0.204	6.128	1.657	1.181～2.325	0.003
MD	0.475	0.199	5.697	1.608	1.168～2.216	0.020
Hcy	0.539	0.175	9.486	1.714	1.270～2.316	0.001

Fig.1 ROC curve of FA，MD and serum Hcy levels for ischemic stroke complicated with carotid plaque

Tab.4 ROC curve results of FA，MD and serum Hcy levels for ischemic stroke complicated with carotid plaque

变量	AUC	标准误	P值	95%CI	最佳临界值	灵敏度（%）	特异度（%）	约登指数
FA	0.830	0.041	0.020	0.855～1.588	1.222	81.39	73.39	0.548
MD	0.820	0.050	0.014	1.360～2.022	1.805	80.11	60.18	0.403
Hcy	0.841	0.043	0.009	0.985～1.270	1.066 μmol/L	82.05	78.40	0.604
FA+MD+Hcy	0.909	0.058	0.001	1.540～2.658	2.023	91.23	89.84	0.811

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