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Original research
Correlation of enlarged perivascular spaces in basal ganglion and cancer-associated stroke: a case–control study in ChinaJielong Wu, Ganji Hong, Liangcheng Zheng, Jiedong Zhao, Lu Yu, Chuya Jing, Qiuhong Zhang, Chen Wang, Xiaodong Yuan, Qing Lin, Zhanxiang Wang, Qilin Ma, Jie Fangdoi: 10.1136/svn-2024-003287
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Stroke & Vascular Neurology（SVN）新近上线文章“Correlation of enlarged perivascular spaces in basal ganglion and cancer-associated stroke: a case–control study in China”，来自厦门大学附属第一医院神经内科马琪林教授、方杰等。癌症相关缺血性卒中（IS）的发病率日益增长。本研究旨在评估癌症相关卒中患者基底神经节血管周围间隙扩大（enlarged perivascular spaces in basal ganglio, BG-EPVS）的水平与对照组的差异，并探讨BG-EPVS在癌症相关卒中中的诊断效用。研究团队开展的这项匹配病例对照研究，共招募了184例IS患者（癌症组与对照组=1:1）。使用高分辨率MRI对BG-EPVS的严重程度进行分级。收集患者的性别、年龄、临床危险因素、入院时的其他影像学改变及实验室检查结果等信息。采用Logistic回归模型，并根据癌症治疗情况进行亚组分析。Figure 2. MRI images (thalamic level) of BG-EPVS (A–D) and lacunar infarction (E–F). T1 (A) and FLAIR (C) show hypointense areas in the basal ganglia on both sides. T2 (B) obtained at the same level shows that these areas are hyperintense. DWI (D) shows no restricted diffusion in these areas. Chronic lacunar infarction is hyperintense on T2 (E), hyperintense on FLAIR (F) or hyperintense at the edge of the central hypointense area due to gliosis (white arrowhead).
Figure 3. Severity level of the BG-EPVS. Degree 1 (A), BG-EPVS<5; degree 2 (B), 5<BG-EPVS<10; degree 3 (C), BG-EPVS>10; degree 4 (D), BG-EPVS=innumerable.
研究结果显示，184例受试者中，65.22%为男性，平均年龄（标准差SD）为68.83±10.52岁。在校正性别、年龄、临床危险因素、其他影像学改变及实验室检查结果后，BG-EPVS对癌症相关卒中的影响显著（OR=1.85, 95%CI 1.29-2.71, p=0.001）。结合BG-EPVS及其他因素的诊断模型的曲线下面积（AUC）为0.848（95%CI 0.787-0.896），显著高于其他三种模型。亚组分析表明，癌症治疗组中BG-EPVS与癌症相关卒中的关联性更强。
Figure 4. Receiver operating characteristic (ROC) curves. (A) Comaparision of ROC curves for four different models (models 1–4). Model 1 includes variables related to age, gender and clinical risk factors. Model 2 additionally includes variables related to other imaging changes on top of model 1. Model 3 further includes variables related to laboratory findings on top of model 2. Model 4 evaluates the impact of BG-EPVS on cancer-associated stroke on top of model 3. A higher AUC represents better predictive performance. (B) Comparison of ROC curves based on different classifications of BG-EPVS. Logistic regression models were constructed based on model 4.
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Figure 5. The relationship of enlarged perivascular spaces in basal ganglion (BG-EPVS) and cancer-associated stroke in each subgroup of cancer treatment.*To prevent model underfitting, we selectively adjusted for four key variables (hypertension, ischaemic lesions regions, platelet count, D-dimer) which significantly associated with cancer-associated stroke in model 4 when assessing the impact of BG-EPVS on cancer-associated stroke across cancer treatment subgroups. The wide CI depicted by the green line may be attributed to the small sample size.
研究结论：本研究是首次评估BG-EPVS对癌症相关卒中的诊断价值的研究，帮助我们理解癌症相关卒中的发病机制。研究结果表明，BG-EPVS在诊断可能携带潜在癌症的IS患者中的有效性。更多内容详见文章原文：https://svn.bmj.com/content/early/2024/11/11/svn-2024-003287，或点击文末“阅读原文”。本文章仅供医疗卫生专业人士为学术交流或了解医学资讯目的使用，不构成对任何药物或治疗方案的推荐和推广。本文章所含信息不应代替医疗卫生专业人士提供的医疗建议。投稿 / 转载 / 商务合作：csa.svn@chinastroke.netEmail：csa.svn@chinastroke.net地址：北京市丰台区南四环西路119号B区1号楼508室本公众号对其刊载的所有内容，包括文字、图片、音视频资料以及版式设计等享有版权，未经本公众号授权同意，其他任何机构不得以任何形式侵犯本公众号作品著作权，包括但不限于：擅自复制、链接、非法使用或转载，或以任何方式建立作品镜像。转载请联系后台或邮箱。如获转载授权，发布请注明出处，不得擅自修改文章内容
