Iomazenil–Single-Photon Emission Computed Tomography Reveals Selective Neuronal Loss in Magnetic Resonance-Defined Mismatch Areas
Iomazenil–Single-Photon Emission Computed Tomography Reveals Selective Neuronal Loss in Magnetic Resonance-Defined Mismatch Areas
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DOI：
10.1161/01.str.0000244827.36393.8f
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发表时间：
2006-11
期刊：
影响因子：
8.3
通讯作者：
D. Saur;R. Buchert;R. Knab;C. Weiller;J. Röther
中科院分区：
文献类型：
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作者：
D. Saur;R. Buchert;R. Knab;C. Weiller;J. Röther
背景和目的——灌注成像上灌注不足的组织与弥散加权成像上缺血组织的不匹配被用作延长时间窗溶栓治疗的替代标志物。不匹配的组织可能完全恢复，进展为梗塞，或进展为不完全梗塞并选择性丧失皮质神经元。我们使用[123I]碘马西尼单光子发射计算机断层扫描（IMZ-SPECT）来表征再灌注“梗塞风险组织”的神经元完整性，该组织在后续磁共振成像（MRI）中表现出形态完整。方法——对 12 名伴有纹状体囊 (SC) 梗死的急性卒中患者在第 0、1 和 7 天进行多模态 MRI 检查；在第 5 天至第 15 天进行 IMZ-SPECT。第 0 天的 PI、第 7 天的液体衰减反转恢复 (FLAIR) 图像和 IMZ-SPECT 进行配准和立体定向归一化。感兴趣的不匹配体积 (VOI) 定义为第 7 天时初始 PI 病变减去 FLAIR 病变。通过将不匹配 VOI 的平均 IMZ 摄取除以未受影响的镜像 VOI 来计算不对称率 (AR)。计算第 7 天 FLAIR 图像上的信号强度时使用相同的 AR。三名患有皮质梗塞的患者被纳入 AR 校准中。在该组中，VOI 由第 7 天的 FLAIR 病变组成。 结果 — 所有 SC 梗塞患者的初始灌注不足（112±31 mL；平均值±SD）和最终梗塞组织（19±14 mL）存在很大不匹配。皮质梗塞中皮质 IMZ 摄取的平均 AR 为 0.85±0.01，SC 梗塞中为 0.95±0.03；因此，在 SC 梗塞中，AR 显示出从明显降低 (0.89) 到正常 (1.01) 的连续分布。皮质梗塞的 FLAIR 信号强度的平均 AR 为 1.84±0.14，SC 梗塞的平均 AR 为 1.01+0.03。结论 — IMZ-SPECT 检测到 SC 梗塞患者的短暂低灌注组织中皮质神经元选择性丢失，而 MRI 上的组织形态完好。
Background and Purpose— The mismatch of hypoperfused tissue on perfusion imaging and ischemic tissue on diffusion-weighted imaging is used as a surrogate marker for thrombolytic therapy in the extended time window. Mismatch tissue may recover completely, progress toward infarction, or proceed toward incomplete infarction with selective loss of cortical neurons. We used [123I]iomazenil–single-photon emission computed tomography (IMZ-SPECT) to characterize the neuronal integrity of reperfused “tissue at risk of infarction” that appeared morphologically intact on follow-up magnetic resonance imaging (MRI). Methods— Twelve patients with acute stroke with striatocapsular (SC) infarctions were examined with multimodal MRI at days 0, 1, and 7; IMZ-SPECT was performed at days 5 to 15. The PI at day 0, fluid-attenuated inversion recovery (FLAIR) image at day 7, and IMZ-SPECT were coregistered and stereotactically normalized. The mismatch volume of interest (VOI) was defined as the initial PI lesion subtracted by the FLAIR lesion at day 7. An asymmetry ratio (AR) was computed by dividing the mean IMZ uptake of the mismatch VOI by the unaffected mirror VOI. The same AR was computed for signal intensity on FLAIR images at day 7. Three patients with cortical infarctions were included for calibration of the AR. In this group, the VOI consisted of the FLAIR lesion at day 7. Results— All patients with SC infarctions had a large mismatch of initially hypoperfused (112±31 mL; mean±SD) and finally infarcted tissue (19±14 mL). Mean AR of cortical IMZ uptake was 0.85±0.01 in cortical infarctions and 0.95±0.03 in SC infarctions; thereby AR showed a continuous distribution from clearly reduced (0.89) to normal (1.01) in SC infarctions. Mean AR for FLAIR signal intensity was 1.84±0.14 for cortical infarctions and normal (1.01+0.03) for SC infarctions. Conclusions— IMZ-SPECT detected a selective loss of cortical neurons in patients with SC infarctions in transient hypoperfused tissue, which was morphologically intact on MRI.