Perfusion computer tomography: imaging and clinical validation in acute ischaemic stroke
Perfusion computer tomography: imaging and clinical validation in acute ischaemic stroke
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DOI：
10.1093/brain/awr257
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发表时间：
2011-11-01
期刊：
影响因子：
14.5
通讯作者：
Parsons, Mark
中科院分区：
文献类型：
--
作者：
Bivard, Andrew;Spratt, Neil;Parsons, Mark
CT灌注成像在急性卒中中的应用需要进一步验证。我们的目的是建立最佳的计算机断层扫描灌注参数定义梗死核心和严重低灌注组织。对314例连续缺血性卒中患者的亚6小时计算机断层扫描灌注和24小时磁共振成像进行了分析。24小时的弥散加权成像病变体积用于定义严重低灌注组织的范围（在急性和24小时时间点之间没有再灌注的患者中）和梗死核心（在24小时有主要再灌注的患者中）。然后使用基于像素的共配准计算机断层扫描灌注和弥散加权成像分析来定义临界低灌注高危组织和梗死核心的最佳计算机断层扫描灌注阈值。然后将这些优化的急性计算机断层扫描灌注阈值病变体积与24小时弥散加权成像梗死体积以及24小时和90天临床结果进行比较以进行验证。相对延迟时间> 2 s是预测严重低灌注组织范围的最准确的计算机断层扫描灌注阈值，接受者工作曲线分析（曲线下面积0.86）和体积验证（计算机断层扫描灌注和24小时弥散加权成像病变之间的平均差异= 2 cm（2），95%置信区间0.5-3.2 cm（2））。相对延迟时间> 2秒灌注损伤内的脑血流量< 40%（对侧）是通过接收器操作特征分析（曲线下面积= 0.85）和体积验证来定义梗死核心的最准确的计算机断层扫描灌注阈值。使用这些阈值，从梗死中挽救的计算机断层扫描灌注不匹配组织（临界低灌注和核心阈值之间的“风险”组织体积）的程度与24 h（R-2 = 0.59，P = 0.04）和90 d（R-2 = 0.42，P = 0.02）时的临床改善相关。基线CT灌注梗死核心体积较大（> 25 ml）的患者在第90天的恢复也较差（P = 0.039）。计算机断层扫描灌注可以准确地识别严重的低灌注组织，进展为梗死，而没有早期再灌注，和计算机断层扫描灌注脑血流梗死核心密切预测梗死组织的最终体积的患者谁做再灌注。计算机断层扫描灌注梗死核心和确定的风险措施也是临床结果的强有力的预测因素。
Computed tomography perfusion imaging in acute stroke requires further validation. We aimed to establish the optimal computed tomography perfusion parameters defining the infarct core and critically hypoperfused tissue. Sub-6-h computed tomography perfusion and 24-h magnetic resonance imaging were analysed from 314 consecutive patients with ischaemic stroke. Diffusion-weighted imaging lesion volume at 24 h was used to define the extent of critically hypoperfused tissue (in patients without reperfusion between acute and 24-h time points), and infarct core (in patients with major reperfusion at 24 h). Pixel-based analysis of co-registered computed tomography perfusion and diffusion-weighted imaging was then used to define the optimum computed tomography perfusion thresholds for critically hypoperfused at-risk tissue and infarct core. These optimized acute computed tomography perfusion threshold-based lesion volumes were then compared with 24-h diffusion-weighted imaging infarct volume, as well as 24-h and 90-day clinical outcomes for validation. Relative delay time > 2 s was the most accurate computed tomography perfusion threshold in predicting the extent of critically hypoperfused tissue with both receiver operating curve analysis (area under curve 0.86), and the volumetric validation (mean difference between computed tomography perfusion and 24-h diffusion-weighted imaging lesions = 2 cm(2), 95% confidence interval 0.5-3.2 cm(2)). Cerebral blood flow < 40% (of contralateral) within the relative delay time > 2 s perfusion lesion was the most accurate computed tomography perfusion threshold at defining infarct core with both receiver operating characteristic analysis (area under curve = 0.85) and the volumetric validation. Using these thresholds, the extent of computed tomography perfusion mismatch tissue (the volume of 'at-risk' tissue between the critically hypoperfused and core thresholds) salvaged from infarction correlated with clinical improvement at 24 h (R-2 = 0.59, P = 0.04) and 90 days (R-2 = 0.42, P = 0.02). Patients with larger baseline computed tomography perfusion infarct core volume (> 25 ml) also had poorer recovery at Day 90 (P = 0.039). Computed tomography perfusion can accurately identify critically hypoperfused tissue that progresses to infarction without early reperfusion, and the computed tomography perfusion cerebral blood flow infarct core closely predicts the final volume of infarcted tissue in patients who do reperfuse. The computed tomography perfusion infarct core and at-risk measures identified are also strong predictors of clinical outcome.