MR Perfusion to Determine the Status of Collaterals in Patients with Acute Ischemic Stroke: A Look Beyond Time Maps
MR Perfusion to Determine the Status of Collaterals in Patients with Acute Ischemic Stroke: A Look Beyond Time Maps
复制标题
磁共振灌注确定急性缺血性中风患者的络脉状态：超越时间图的观察
DOI：
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发表时间：
2017
影响因子：
3.5
通讯作者：
Max Wintermark
中科院分区：
文献类型：
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作者：
K. Nael;Amish H. Doshi;R. Leacy;J. Puig;M. Castellanos;Joshua B. Bederson;T. P. Naidich;J. Mocco;Max Wintermark
背景和目的：具有强劲侧支血流的急性卒中患者具有更好的临床结局，并可能在延长的时间窗内从血管内治疗中获益。使用多参数方法，我们的目的是确定MR灌注参数，可以代表侧支血管的程度，近似DSA。材料和方法：对具有基线MR灌注和DSA的前循环近端动脉闭塞患者进行评价。使用VOI分析计算在2-6秒（ATD 2 -6秒）和>6秒（ATD>6秒）阈值下的动脉组织延迟（ATD）的体积以及标准化CBV和CBF的相应值。通过多因素分析评估MR灌注参数与DSA侧支循环状态之间的关系。进行受试者工作特征分析。结果：在108例患者中，39例符合我们的纳入标准。DSA显示22/39例（56%）侧支循环良好。与侧支循环不足的患者相比，侧支循环良好的患者具有显著较小的基线和最终梗死体积、较小的重度低灌注体积（ATD>6秒）、较大的中度低灌注体积（ATD 2 -6秒）以及较高的相对CBF和相对CBV值。将这2个参数组合为灌注侧支循环指数（ATD 2 -6秒体积×相对CBV 2 -6秒），预测侧支循环状态的准确性最高：在阈值61.7时，该指数识别出15/17（88%）例侧支循环不足的患者和22/22（100%）例侧支循环良好的患者，总体准确性为94.1%。结论：与DSA相比，灌注侧支循环指数可以预测基线侧支循环状态，诊断准确率为94%。
BACKGROUND AND PURPOSE: Patients with acute stroke with robust collateral flow have better clinical outcomes and may benefit from endovascular treatment throughout an extended time window. Using a multiparametric approach, we aimed to identify MR perfusion parameters that can represent the extent of collaterals, approximating DSA. MATERIALS AND METHODS: Patients with anterior circulation proximal arterial occlusion who had baseline MR perfusion and DSA were evaluated. The volume of arterial tissue delay (ATD) at thresholds of 2–6 seconds (ATD2–6 seconds) and >6 seconds (ATD>6 seconds) in addition to corresponding values of normalized CBV and CBF was calculated using VOI analysis. The association of MR perfusion parameters and the status of collaterals on DSA were assessed by multivariate analyses. Receiver operating characteristic analysis was performed. RESULTS: Of 108 patients reviewed, 39 met our inclusion criteria. On DSA, 22/39 (56%) patients had good collaterals. Patients with good collaterals had significantly smaller baseline and final infarct volumes, smaller volumes of severe hypoperfusion (ATD>6 seconds), larger volumes of moderate hypoperfusion (ATD2–6 seconds), and higher relative CBF and relative CBV values than patients with insufficient collaterals. Combining the 2 parameters into a Perfusion Collateral Index (volume of ATD2–6 seconds × relative CBV2–6 seconds) yielded the highest accuracy for predicting collateral status: At a threshold of 61.7, this index identified 15/17 (88%) patients with insufficient collaterals and 22/22 (100%) patients with good collaterals, for an overall accuracy of 94.1%. CONCLUSIONS: The Perfusion Collateral Index can predict the baseline collateral status with 94% diagnostic accuracy compared with DSA.