Visual perfusion-diffusion mismatch is equivalent to quantitative mismatch.
Visual perfusion-diffusion mismatch is equivalent to quantitative mismatch.
复制标题
视觉灌注-扩散不匹配相当于定量不匹配。
DOI：
10.1161/strokeaha.110.603290
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发表时间：
2011
期刊：
影响因子：
8.3
通讯作者：
Warach,Steven
中科院分区：
文献类型：
--
作者：
Luby,Marie;Ku,KatherineD;Latour,LawrenceL;Merino,JoséG;Hsia,AmieW;Lynch,JohnK;Warach,Steven
背景与目的基于弥散加权成像（DWI）与灌注加权成像（PWI）定性评价的脑卒中MRI失配概念已在临床实践中应用多年。MRI在溶栓治疗前提供缺血病理证据方面的益处已得到证实。本研究的目的是确定定性方法的可靠性，并将其与溶栓治疗患者的定量错配测量进行比较。方法从脑卒中和缺血性神经影像学（病灶）数据库中选择患者70例，符合以下条件：(1)静脉注射重组组织型纤溶酶原激活剂；(2) MRI预处理，DWI和PWI可评估；(3)经核心成像实验室测量，DWI显示急性缺血性病变体积bbb10 mL。定量失配定义为异常平均传输时间与DWI体积之间的差异为bbb50 mL。采用定性和定量方法对失配阳性患者的样本特征和出院后改良Rankin量表进行比较。结果通过定性和定量方法确定的错配患者的患者特征和溶栓结局（性别、年龄、美国国立卫生研究院卒中量表、错配体积和改良Rankin量表）没有差异。与定量测量相比，神经科医师的定性错配选择具有较高的敏感性（0.82）、特异性（0.80）、准确性（0.81）和阳性预测值（0.88）。结论：我们观察到，与回顾性定量失配测量相比，定性失配评估可识别相同的溶栓治疗患者。
Background and PurposeThe concept of stroke MRI mismatch based on qualitative evaluation of diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) has been applied in clinical practice for several years. The benefit of MRI in providing pathological evidence of ischemia before thrombolytic treatment has been demonstrated. The purpose of this study is to determine the reliability of the qualitative method and compare it with quantitative mismatch measurement in thrombolytic-treated patients.MethodsPatients (n=70) were selected from the Lesion Evolution of Stroke and Ischemic On Neuroimaging (LESION) database if they: (1) were treated with intravenous recombinant tissue plasminogen activator; (2) had a pretreatment MRI with evaluable DWI and PWI; and (3) had acute ischemic lesion volume >10 mL on DWI as determined by core imaging laboratory measurements. Quantitative mismatch was defined as a difference of >50 mL between abnormal mean transit time and DWI volumes. Sample characteristics and postdischarge modified Rankin Scale for the positive mismatch patients were compared between the subgroups identified by qualitative versus quantitative methods.ResultsPatient characteristics and thrombolytic outcomes (sex, age, National Institutes of Health Stroke Scale, mismatch volume, and modified Rankin Scale) did not differ for mismatch patients identified by qualitative versus quantitative methods. Qualitative mismatch selection among neurologists had a high sensitivity (0.82), specificity (0.80), accuracy (0.81), and positive predictive value (0.88) compared with quantitative measurements.ConclusionsWe observed that qualitative evaluation of mismatch identified the same thrombolytic-treated patients compared with retrospective quantitative mismatch measurements.