Impact on stroke subtype diagnosis of early diffusion-weighted magnetic resonance imaging and magnetic resonance angiography
Impact on stroke subtype diagnosis of early diffusion-weighted magnetic resonance imaging and magnetic resonance angiography
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DOI：
10.1161/01.str.31.5.1081
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发表时间：
2000-05-01
期刊：
影响因子：
8.3
通讯作者：
Saver, JL
中科院分区：
文献类型：
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作者：
Lee, LJ;Kidwell, CS;Saver, JL
背景和目的-本研究的目的是评估早期弥散加权MRI（DWI）和MR血管造影（MRA）对缺血性卒中患者的诊断价值。过去的中风诊断方法需要在住院几天内进行一系列诊断测试。新的磁共振方法，包括DWI和MRA可能允许更快速的中风病理生理特征。然而，没有以前的研究已经评估了正式的中风亚型诊断的早期成像DWI/MRA的影响。方法，我们分析了46例连续急性缺血性中风谁在入院后24小时内进行DWI/MRA。使用2种最广泛使用的正式卒中亚型分类方案（吐司和Oxfordshire方法）进行初步诊断，这些方法应用于CT/常规MRI后但DWI/MRA前的患者，然后根据第1天DWI、MRA和DWI + MRA的结果进行改良吐司和Oxfordshire诊断。出院时的最终吐司/Oxfordshire诊断被作为金标准。结果与最终诊断相比，MRI前：吐司诊断与最终诊断的匹配率为48%，单独DWI后为83%，单独MRA后为56%，DWI + MRA后为94%。对于大血管动脉粥样硬化血栓栓塞和小血管疾病的吐司诊断亚型，MRI前诊断分别与56%和35%的患者的最终诊断相匹配，DWI/MRA后分别提高到89%和100%。前MRI牛津郡的诊断匹配的最终诊断的67%的患者，提高到100%后DWI. Conclusion-The使用DWI/MRA住院24小时内大大提高了早期缺血性中风亚型的诊断准确性。当初始管理和临床试验资格决定受到卒中亚型的影响时，第1天多模式MRI作为治疗指南是有利的。
Background and Purpose-The purpose of the present study was to assess the diagnostic usefulness of early diffusion-weighted MRI (DWI) and MR angiography (MRA) in patients with ischemic stroke. Past approaches to stroke diagnosis required a series of diagnostic tests over several days of hospitalization. New magnetic resonance methodologies that include DWI and MRA may allow more rapid characterization of stroke pathophysiology. However, no previous study has assessed the impact on formal stroke subtype diagnosis of early imaging with DWI/MRA.Methods-We analyzed 46 consecutive patients with acute ischemic stroke who underwent DWI/MRA within 24 hours of admission. Initial diagnoses were rendered with use of the 2 most widely used formal stroke subtype classification schemes, the TOAST and the Oxfordshire methods, which were applied to patients after CT/conventional MRI but before DWI/MRA, Modified TOAST and Oxfordshire diagnoses were then rendered based on the results of day 1 DWI, MRA, and DWI plus MRA. Final TOAST/Oxfordshire diagnoses at discharge were taken as the gold standard.Results-Compared with final diagnoses, pre-MRI: TOAST diagnoses matched final diagnoses in 48%, improving to 83% after DWI alone, 56% after MRA alone, and 94% after DWI plus MRA. For the TOAST diagnostic subtypes of large-vessel atherothromboembolism and small-vessel disease, pre-MRI diagnoses matched final diagnoses in 56% and 35% of patients, respectively, improving to 89% and 100% after DWI/MRA. Pre-MRI Oxfordshire diagnoses matched final diagnoses in 67% of patients, improving to 100% after DWI.Conclusions-The use of DWI/MRA within 24 hours of hospitalization substantially improves the accuracy of the diagnosis of early ischemic stroke subtype. When initial management and clinical trial eligibility decisions are influenced by stroke subtype, day 1 multimodal MRI is advantageous as a guide to therapy.