Diffusion-and perfusion-weighted MRI -: The DWI/PWI mismatch region in acute stroke
Diffusion-and perfusion-weighted MRI -: The DWI/PWI mismatch region in acute stroke
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DOI：
10.1161/01.str.30.8.1591
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发表时间：
1999-08-01
期刊：
影响因子：
8.3
通讯作者：
Freund, HJ
中科院分区：
文献类型：
--
作者：
Neumann-Haefelin, T;Wittsack, HJ;Freund, HJ
背景和目的-弥散加权成像（DWI）和灌注加权成像（PWI）是相对较新的MR技术，越来越多地用于急性卒中。在卒中进展的最初几个小时，灌注异常的区域通常大于DWI病灶，这种不匹配的区域被认为是“危险组织”。本研究的目的是评估PWI/DWI不匹配区域急性中风患者，并找到参数指示梗死进展和功能immortals.Methods-Twenty与nonlacunar缺血性中风患者进行了成像DWI，PWI，和传统的MRT在24小时内的症状发作和1周后，此外，欧洲中风量表（ESS）评分记录。与PWI，体积的区域与“时间到峰值”（TTP）延迟大于或等于2，4，6，8，和10秒进行了测量，这些体积进行了比较，急性DWI病变体积，最终梗死面积，和ESS score.Results-In 80%的患者急性DWI病变周围的区域异常TTP延迟（PWI>DWI病变）。发现不匹配区域的TTP延迟大于或等于6 s与初始和随访MRI扫描之间的病变扩大相关。TTP延迟大于或等于6 a的区域大于DWI病变的12例患者中有9例（75%）病变增加，但其余8例患者中只有1例（12.5%）病变增加，其中TTP延迟大于或等于6 s的区域小于DWI病变。TTP延迟大于或等于4 s的区域体积与ESS相关性更好（r =-0.88，P < 0.001），提示TTP延迟约4 s可能是脑组织功能损害的阈值。结论-仅PWI/DWI不匹配的严重灌注缺损患者（TTP延迟大于或等于6秒）是病变扩大的高风险。在功能上，更中度的灌注缺陷（TTP延迟大于或等于4，
Background and Purpose-Diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) are relatively new MR techniques increasingly used in acute stroke. During the first hours of stroke evolution, the regions with abnormal perfusion are typically larger than the DWI lesions, and this mismatch region has been suggested to be "tissue at risk." The aim of this study was to evaluate the PWI/DWI mismatch region in acute stroke patients and find parameters indicative of both infarct progression and functional impairment.Methods-Twenty patients with nonlacunar ischemic stroke were imaged with DWI, PWI, and conventional MRT within 24 hours of symptom onset and after 1 week; in addition, the European Stroke Scale (ESS) score was recorded. With PWI, the volumes of regions with "time-to-peak" (TTP) delays of greater than or equal to 2, 4, 6, 8, and 10 seconds were measured; these volumes were compared with the acute DWI lesion volumes, final infarct size, and ESS score.Results-In 80% of patients the acute DWI lesion was surrounded by regions with abnormal TTP delays (PWI>DWI lesion). A TTP delay of greater than or equal to 6 s in the mismatch region was found to be associated with lesion enlargement between the initial and follow-up MRI scans. Lesions increased in 9 of 12 patients (75%) in whom the area with TTP delay greater than or equal to 6 a was larger than the DWI lesion, but they increased in only I of 8 (12.5%) of the remaining patients, in whom the area with a TTP delay greater than or equal to 6 s was smaller than the DWI lesion. The volume of the regions with TTP delays of greater than or equal to 4 s correlated better with ESS (r = -0.88, P < 0.001) than other PWI (or DWI) volumes, which indicated that a TTP delay of approximate to 4 s might be the threshold for functional impairment of brain tissue.Conclusions-Only patients with severe perfusion deficits in the PWI/DWI mismatch (TTP delays of greater than or equal to 6 s) are at high risk of lesion enlargement. Functionally, more moderate perfusion deficits (TTP delays greater than or equal to 4 and