MRI-based selection for intra-arterial stroke therapy: value of pretreatment diffusion-weighted imaging lesion volume in selecting patients with acute stroke who will benefit from early recanalization.
MRI-based selection for intra-arterial stroke therapy: value of pretreatment diffusion-weighted imaging lesion volume in selecting patients with acute stroke who will benefit from early recanalization.
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DOI：
10.1161/strokeaha.108.541656
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发表时间：
2009-06
期刊：
影响因子：
8.3
通讯作者：
González RG
中科院分区：
文献类型：
--
作者：
Yoo AJ;Verduzco LA;Schaefer PW;Hirsch JA;Rabinov JD;González RG
最近的研究表明，急性弥散加权成像（DWI）病变体积> 70 cm3预测中风患者预后不良。我们试图确定这个阈值是否可以识别接受动脉内治疗（IAT）的患者，这些患者尽管再灌注，但表现不佳。在初始梗死<70 cm 3的患者中，我们试图确定再通和再通时间对梗死生长和功能结果有何影响。我们回顾性研究了34例连续的前循环卒中患者，这些患者接受了治疗前DWI和灌注加权成像（PWI）以及随后的IAT。记录再通成功率和再通时间。测定初始DWI和MTT病变和最终梗死体积。根据初始梗死体积、再通状态和再通时间对患者进行分层。进行统计学检验以评估临床和影像学结局的差异。良好临床结局定义为3个月mRS≤2。在初始梗死面积> 70 cm 3的患者中，尽管再通率为50%，但所有患者的预后均较差，平均梗死面积为114 cm 3。这些患者也具有最大的MTT体积（p<0.04）。早期再通的初始梗死体积<70 cm 3的患者具有最佳临床结局（p<0.008），64%的mRS≤2，梗死生长最少（p<0.03），平均生长18 cm 3。本研究支持使用急性DWI病变体积阈值作为IAT的成像选择标准。这也证实了在选定的患者中早期再灌注的重要性。
Recent studies demonstrate that an acute diffusion weighted imaging(DWI) lesion volume >70cm3 predicts poor outcome in stroke patients. We sought to determine if this threshold could identify patients treated with intra-arterial therapy(IAT) who would do poorly despite reperfusion. In patients with initial infarcts <70cm3, we sought to determine what effect recanalization and time to recanalization had on infarct growth and functional outcome. We retrospectively studied 34 consecutive anterior circulation stroke patients who underwent pre-treatment DWI and perfusion weighted imaging(PWI) and subsequent IAT. Recanalization success and time to recanalization were recorded. Initial DWI and MTT lesion and final infarct volumes were determined. Patients were stratified based on initial infarct volume, recanalization status and time to recanalization. Statistical tests were performed to assess differences in clinical and imaging outcomes. Good clinical outcome was defined as a 3-month mRS≤2. Among patients with initial infarcts >70cm3, all had poor outcomes despite a 50% recanalization rate, with mean infarct growth of 114cm3. These patients also had the largest MTT volumes(p<0.04). Patients with initial infarct volumes <70cm3 who recanalized early had the best clinical outcomes(p<0.008) with a 64% rate of mRS≤2 and the least infarct growth(p<0.03), with mean growth of 18cm3. This study supports the use of an acute DWI lesion volume threshold as an imaging selection criterion for IAT. It also confirms the importance of early reperfusion in selected patients.