Distal hyperintense vessels on FLAIR An MRI marker for collateral circulation in acute stroke?
Distal hyperintense vessels on FLAIR An MRI marker for collateral circulation in acute stroke?
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DOI：
10.1212/01.wnl.0000345360.80382.69
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发表时间：
2009-03-31
期刊：
影响因子：
9.9
通讯作者：
Warach, S.
中科院分区：
文献类型：
--
作者：
Lee, K. Y.;Latour, L. L.;Warach, S.
背景：在急性缺血性脑卒中患者中，液体衰减反转恢复成像经常观察到高强度血管（HV）。然而，这一症状的确切机制和临床意义尚未明确定义。本文介绍了HV的特征及其与其他影像学因素的相关性。方法：对连续52例大脑中动脉（MCA）梗死患者在静脉注射重组组织型纤溶酶原激活剂治疗前的HV表现及部位进行记录。测定预处理缺血病灶体积、灌注病灶体积、血管闭塞情况，随访影像学再通状态和缺血病灶体积。采用NIH卒中量表（NIHSS）作为临床严重程度的衡量标准。结果：73%的患者出现动脉远端HV闭塞；在近端比远端MCA闭塞患者中更常见。在38例近端MCA闭塞患者中，不同级别远端HV患者的初始灌注病变体积具有可比性。然而，远端HV更突出的患者初始、24小时和亚急性缺血性病变体积较小，初始NIHSS评分较低。结论：溶栓治疗前存在远端高强度血管与大脑中动脉近端闭塞患者弥散-灌注失配大、亚急性缺血性病变体积小有关。神经病学(R) 2009；72:1134 - 1139
Background: Hyperintense vessels (HV) on fluid-attenuated inversion recovery imaging are frequently observed in acute ischemic stroke patients. However, the exact mechanism and clinical implications of this sign have not yet been clearly defined. The features of HV and its relevance to other imaging factors are presented here.Methods: Prominence and location of HV were documented in 52 consecutive patients with middle cerebral artery (MCA) territory infarction, before treatment with IV recombinant tissue plasminogen activator. Pretreatment ischemic lesion volume, perfusion lesion volume, and vessel occlusion were determined in addition to recanalization status and ischemic lesion volume on follow-up imaging. NIH Stroke Scale (NIHSS) was used as a measure of clinical severity.Results: HV distal to arterial occlusion was observed in 73% of patients; more frequent in proximal than distal MCA occlusion patients. Among the 38 patients with proximal MCA occlusion, initial perfusion lesion volume was comparable among patients with different grade distal HV. However, patients with more prominent distal HV had smaller initial, 24-hour, and subacute ischemic lesion volumes and lower initial NIHSS scores.Conclusions: The presence of distal hyperintense vessels before thrombolytic treatment is associated with large diffusion-perfusion mismatch and smaller subacute ischemic lesion volumes in patients with proximal middle cerebral artery occlusion. Neurology (R) 2009;72:1134-1139