Early [11C]flumazenil/H2O positron emission tomography predicts irreversible ischemic cortical damage in stroke patients receiving acute thrombolytic therapy
Early [11C]flumazenil/H2O positron emission tomography predicts irreversible ischemic cortical damage in stroke patients receiving acute thrombolytic therapy
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DOI：
10.1161/01.str.31.2.366
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发表时间：
2000-02-01
期刊：
影响因子：
8.3
通讯作者：
Pawlik, G
中科院分区：
文献类型：
--
作者：
Heiss, WD;Kracht, L;Pawlik, G
背景和目的-中枢苯二氮卓类受体配体，如[C-11]氟马西尼（FMZ），是神经元完整性的标志物，因此可能有助于缺血性卒中早期功能和形态受损组织的鉴别。我们试图评估苯二氮卓受体配体对早期识别不能从再灌注中获益的皮质区域不可逆缺血性损伤的价值。（7例男性，4例女性，年龄52 - 75岁）急性半球缺血性卒中患者接受阿替普酶治疗（重组组织纤溶酶原激活剂，0.9mg/kg，根据国立神经疾病和中风研究所方案）。在溶栓开始时，通过正电子发射断层扫描（PET）评估皮质脑血流量（[O-15]H2O）和FMZ结合。这些早期的PET结果与神经功能缺损的变化（美国国立卫生研究院卒中量表）和脑皮层损伤的程度在MRI或CT 3周后stroke. Results-Hypoproperfusion观察在所有情况下，并在8例患者的值低于临界阈值估计在12毫升/100克每分钟。包括1至174 cm（3）的皮质组织。溶栓后24小时，在这些区域中的大多数中观察到大量再灌注。在4例病例中，检测到FMZ结合减少的明显区域。这些患者的皮质区出现永久性病变，与FMZ缺损相对应（112与146，3与3，2与1，128与136 cm（3））。在其他患者中，MRI或CT未检测到形态学缺陷，尽管在溶栓前78 cm（3）范围内的区域血流严重减少，但这些发现表明，FMZ PET对苯二氮卓类受体的成像可区分急性卒中后早期不可逆损伤的半暗带组织和存活半暗带组织。
Background and Purpose-Central benzodiazepine receptor ligands, such as [C-11]flumazenil (FMZ), are markers of neuronal integrity and therefore might be useful in the differentiation of functionally and morphologically damaged tissue early ill ischemic stroke. We sought to assess the value of a benzodiazepine receptor ligand for the early identification of irreversible ischemic damage to cortical areas that cannot benefit from reperfusion.Methods-Eleven patients (7 male, 4 female, aged 52 to 75 years) with acute, hemispheric ischemic stroke were treated with alteplase (recombinant tissue plasminogen activator, 0.9 mg/kg according to National Institute of Neurological Disorders and Stroke protocol) within 3 hours of onset of symptoms. At the beginning of thrombolysis, cortical cerebral blood flow ([O-15]H2O) and FMZ binding were assessed by positron emission tomography (PET). Those early PET findings were related to the change in neurological deficit (National Institutes of Health Stroke Scale) and to the extent of cortical damage on MRI or CT 3 weeks after the stroke.Results-Hypoperfusion was observed in all cases, and in 8 patients the values were below critical thresholds estimated at 12 mL/100 g per minute. comprising 1 to 174 cm(3) of cortical tissue. Substantial reperfusion was seen in most of these regions 24 hours after thrombolysis. In 4 cases, distinct areas of decreased FMZ binding were detected. Those patients suffered permanent lesions in cortical areas corresponding to their FMZ defects (112, versus 146, 3 versus 3, 2 versus 1, and 128 versus 136 cm(3)). In the other patients no morphological defects were detected on MRI or CT, although blood flow was critically decreased in areas ranging in size up to 78 cm(3) before thrombolysis.Conclusions-These findings suggest that imaging of benzodiazepine receptors by FMZ PET distinguishes between irreversibly damaged and viable penumbra tissue early after acute stroke.