Combining Acute Diffusion-Weighted Imaging and Mean Transmit Time Lesion Volumes With National Institutes of Health Stroke Scale Score Improves the Prediction of Acute Stroke Outcome
Combining Acute Diffusion-Weighted Imaging and Mean Transmit Time Lesion Volumes With National Institutes of Health Stroke Scale Score Improves the Prediction of Acute Stroke Outcome
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DOI：
10.1161/strokeaha.110.582874
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发表时间：
2010-08-01
期刊：
影响因子：
8.3
通讯作者：
Schaefer, Pamela W.
中科院分区：
文献类型：
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作者：
Yoo, Albert J.;Barak, Elizabeth R.;Schaefer, Pamela W.
背景和目的-本研究的目的是确定急性弥散加权成像（DWI）和平均通过时间（MTT）病变体积以及国立卫生研究院卒中量表（NIHSS）是否可以识别急性缺血性卒中患者，这些患者具有良好和不良结局的高概率。随访3个月，采用改良兰金量表评定疗效。计算急性DWI和MTT病变体积和基线NIHSS评分。如果改良兰金评分为0 ~ 2分，则认为临床结局良好。结果：与结局较差的患者相比，结局良好的患者中有33例（61%）DWI病灶体积明显较小（P= 0.0001），MTT病灶体积明显较小（P <0.0001），NIHSS评分明显较低（P < 0.0001）。DWI、MTT和NIHSS相对于不良结局的受试者工作特征曲线的曲线下面积分别为0.889、0.854和0.930，无显著差异。DWI和MTT病变体积预测结果优于不匹配体积或百分比不匹配。所有DWI体积> 72 mL（13/54）和NIHSS评分> 20（6/54）的患者结局均较差。MTT体积< 47 mL（16/54）和NIHSS评分< 8（17/54）的所有患者均具有良好结局。结合临床和影像学阈值提高预后率（70%）超过临床（43%）或影像学（54%）阈值单独（P=0.01）。结论-结合定量DWI和MTT与NIHSS预测良好和不良结局的概率很高，是上级优于NIHSS单独。（中风。2010;41：1728-1735）。
Background and Purpose-The purpose of this study was to determine whether acute diffusion-weighted imaging (DWI) and mean transit time (MTT) lesion volumes and presenting National Institutes of Health Stroke Scale (NIHSS) can identify patients with acute ischemic stroke who will have a high probability of good and poor outcomes.Methods-Fifty-four patients with acute ischemic stroke who had MRI within 9 hours of symptom onset and 3-month follow-up with modified Rankin scale were evaluated. Acute DWI and MTT lesion volumes and baseline NIHSS scores were calculated. Clinical outcomes were considered good if the modified Rankin Scale was 0 to 2.Results-The 33 of 54 (61%) patients with good outcomes had significantly smaller DWI lesion volumes (P=0.0001), smaller MTT lesion volumes (P < 0.0001), and lower NIHSS scores (P < 0.0001) compared with those with poor outcomes. Receiver operating characteristic curves for DWI, MTT, and NIHSS relative to poor outcome had areas under the curve of 0.889, 0.854, and 0.930, respectively, which were not significantly different. DWI and MTT lesion volumes predicted outcome better than mismatch volume or percentage mismatch. All patients with a DWI volume > 72 mL (13 of 54) and an NIHSS score > 20 (6 of 54) had poor outcomes. All patients with an MTT volume of < 47 mL (16 of 54) and an NIHSS score < 8 (17 of 54) had good outcomes. Combining clinical and imaging thresholds improved prognostic yield (70%) over clinical (43%) or imaging (54%) thresholds alone (P=0.01).Conclusions-Combining quantitative DWI and MTT with NIHSS predicts good and poor outcomes with high probability and is superior to NIHSS alone. (Stroke. 2010;41:1728-1735.)