中文摘要：

目的 探讨磁共振液体衰减反转恢复序列血管高信号（FVH）与静脉溶栓预后的关系.方法 回顾性分析浙江大学医学院附属第二医院神经内科2009年5月至2013年12月连续收集的缺血性卒中静脉溶栓患者的临床和影像资料.选取前循环梗死的病例,评估大脑中动脉远端供血区域FVH的情况,并分析其与溶栓后再灌注以及临床预后的关系.结果 共纳入93例患者,55例（59.1％）存在FVH,较FVH阴性者基线美国国立卫生院神经功能缺损评分（NIHSS;分）更高（11.8±6.0与7.2 ±4.5,t =-4.82,P＜0.01）,弥散加权成像所显示的病灶更大（中位数分别为5.5 ml与2.0 ml,Z=-3.030,P=0.002）、灌注成像低灌注区更大（中位数分别为42.0 ml与3.0 ml,Z=-6.104,P=0.005）,差异均有统计学意义.其中FVH阳性的独立影响因素为近端大血管闭塞（OR =48.874,95％ CI 11.6～205.9,P＜0.01）和高脂血症病史（OR =0.264,95％CI 0.07～0.90,P=0.048）.FVH阳性是3个月预后不良的独立危险因素（OR =4.143,95％CI 1.440～11.919,P=0.008）,但FVH伴早期再灌注则能明显改善3个月预后（OR=8.500,95％CI1.964～36.790,P=0.004）.结论 FVH的存在与近端大血管闭塞有关,且影响静脉溶栓远期预后.早期再灌注可改善FVH阳性者的溶栓预后.

英文摘要：

Objective To explore the prognostic effect of fluid-attenuated inversion recovery imaging vascular hyperintensity （FVH）on intravenous thrombolysis of acute ischemic stroke.Methods We retrospectively reviewed the clinical and imaging data of intravenous thrombolytic patients with acute anterior circulation infarction admitted from May 2009 to December 2013.The presence of FVH was evaluated,and its associations with reperfusion and clinical outcome after thrombolysis were assessed.Results Ninety-three patients were analyzed.FVH was detectable in 55 （59.1％） cases.Patients with FVH had higher NIHSS scores （11.8 ± 6.0 vs 7.2 ± 4.5,P ＜ 0.01）,larger initial DWI lesions （5.5 ml vs 2.0 ml,Z =-3.030,P=0.002） and perfusion lesions （42.0 ml vs 3.0 ml,Z=-6.104,P =0.005）,compared with those without FVH.The history of hyperlipidemia （OR =0.264,95％ CI 0.07-0.90,P =0.048） and proximal large vessel occlusion（OR =48.874,95％ CI 11.6-205.924,P ＜ 0.01） were independently associated with the presence of FVH.The presence of FVH independently predicted the poor neurological outcome at 3 months （OR =4.143,95 ％ CI 1.440-11.919,P =0.008）.However,early reperfusion was associated with favorable outcome in patients with FVH after intravenous thrombolysis （OR =8.500,95％ CI 1.964-36.790,P =0.004）.Conclusions The presence of FVH is associated with proximal large vessel occlusion,which predicts poor outcome in patients with intravenous thrombolysis.However,early reperfusion among patients with FVH can improve the outcome.