Prediction of stroke outcome with echoplanar perfusion- and diffusion-weighted MRI
Prediction of stroke outcome with echoplanar perfusion- and diffusion-weighted MRI
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DOI：
10.1212/wnl.51.2.418
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发表时间：
1998-08-01
期刊：
影响因子：
9.9
通讯作者：
Davis, SM
中科院分区：
文献类型：
--
作者：
Barber, PA;Darby, DG;Davis, SM
目的：我们研究了在18种急性半球梗死患者中预测中风的演变和预测结果中的磁性磁共振灌注成像和扩散加权成像（DWI）的实用性。方法：在24小时内研究患者（平均12.2小时），次余（平均4.7天）和结果（平均值为84天）。在灌注成像（PI）和各向同性DWI图，临床评估量表（加拿大神经系统量表，Barthel Index和RankIn量表）以及最终的Infarct体积（T2赋予MRI）上进行了比较。结果：急性PI病变体积与急性神经系统，临床结果和最终梗死体积相关。急性DWI病变与急性神经系统态的牢固相关，但与临床结局和最终梗塞量息息相关。看到了六种可能的异常模式中的三个：大于DWI病变（65％）的PI病变，小于DWI病变（12％）和DWI病变，但没有PI病变（23％）。大于DWI病变大的PI病变的模式预测DWI扩展到周围的炎性组织中（P <0.05）。在其他两种模式中，DWI病变并未扩大，这表明在没有较大灌注不足的情况下，缺血性病变大小没有显着增加。结论：早期PI和DWI组合可以定义不同的急性梗塞模式，这可能允许根据存在或不存在潜在可挽救的缺血组织来选择理性的治疗策略。
Objectives: We examined the utility of echoplanar magnetic resonance perfusion imaging and diffusion-weighted imaging (DWI) in predicting stroke evolution and outcome in 18 patients with acute hemispheric infarction. Methods: Patients were studied within 24 hours (mean, 12.2 hours), subacutely (mean, 4.7 days), and at outcome (mean, 84 days). Comparisons were made between infarction volumes as measured on perfusion imaging (PI) and isotropic DWI maps, clinical assessment scales (Canadian Neurological Scale, Barthel Index, and Rankin Scale), and final infarct volume (T2-weighted MRI). Results: Acute PI lesion volumes correlated with acute neurologic state, clinical outcome, and final infarct volume. Acute DWI lesions correlated less robustly with acute neurologic state, but correlated well with clinical outcome and final infarct volume. Three of six possible patterns of abnormalities were seen: PI lesion larger than DWI lesion (65%), PI lesion smaller than DWI lesion (12%), and DWI lesion but no PI lesion (23%). A pattern of a PI lesion larger than the DWI lesion predicted DWI expansion into surrounding hypoperfused tissue (p < 0.05). In the other two patterns, DWI lesions did not enlarge, suggesting that no significant increase in ischemic lesion size occurs in the absence of a larger perfusion deficit. Conclusions: Combined early PI and DWI can define different acute infarct patterns, which may allow the selection of rational therapeutic strategies based on the presence or absence of potentially salvageable ischemic tissue.