Complete Early Reversal of Diffusion-Weighted Imaging Hyperintensities After Ischemic Stroke Is Mainly Limited to Small Embolic Lesions
Complete Early Reversal of Diffusion-Weighted Imaging Hyperintensities After Ischemic Stroke Is Mainly Limited to Small Embolic Lesions
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DOI：
10.1161/strokeaha.111.676346
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发表时间：
2013-04-01
期刊：
影响因子：
8.3
通讯作者：
Nolte, Christian H.
中科院分区：
文献类型：
--
作者：
Albach, Fredrik N.;Brunecker, Peter;Nolte, Christian H.
背景和目的：病例报告显示，在临床诊断为中风后，弥散加权成像(DWI)的高信号在早期完全逆转。我们旨在系统地研究卒中后第一周可逆性弥散高信号(RDHs)的发生率和特点。方法：选择临床诊断为急性脑血管事件并经DWI证实为脑缺血的患者。在入院时、第二天和症状出现后4至7天进行MRI扫描，并进行弥散加权成像和液体衰减反转恢复。基线和随访的弥散加权成像被共同登记，并检查单个RDH。结果：我们纳入了153名患者，美国国立卫生研究院卒中评分中位数为4(四分位数范围为2-8)。3例(2%)MR图像完全正常。37例患者(24%)表现为个体化的RDH。在611个初始DWI高信号中，97个(16%)被逆转。在第三次测量时，13%的RDH在流体衰减的反转恢复图像上有相应的异常。RDH的平均大小为0.029毫升(四分位数范围为0.013-0.055)。RDH与多发性脑梗塞(优势比为22.1；95%可信区间为4.5-109.7)和症状性颈动脉狭窄(优势比为5.5；95%可信区间为1.4-21.5)相关。59%的RDH患者在后续的DWI检查中有新的额外病变。在美国国立卫生研究院卒中量表评分中，RDH与功能改善无关。结论--在这个以轻至中度卒中患者为主的人群中，MR图像的完全正常化是罕见的。单个弥散加权像高信号的完全逆转仅限于非常小的病变，且大多发生在栓塞性中风患者中。临床试验注册-网址：http://www.clinicaltrials.gov.Unique识别符：NCT00715533。(笔划。2013年；44：10431048。)
Background and Purpose-Case reports have demonstrated complete early reversal of hyperintensities on diffusion-weighted imaging (DWI) after clinically diagnosed stroke. We aimed to investigate systematically the rate and characteristics of reversible diffusion hyperintensities (RDHs) in the first week after stroke.Methods-Patients with clinical diagnosis of an acute cerebrovascular event and evidence of ischemia on DWI were included. MRI scans were performed on admission, on the following day, and 4 to 7 days after onset of symptoms with DWI and fluid-attenuated inversion recovery. Baseline and follow-up DWIs were coregistered and examined for individual RDHs. Characteristics of patients and of hyperintensities associated with early reversal were identified.Results-We included 153 patients with a median National Institutes of Health Stroke Scale score of 4 (interquartile range, 2-8). In 3 patients (2%), MR images normalized completely. Thirty-seven patients (24%) displayed individual RDHs. Of 611 initial DWI hyperintensities, 97 (16%) reversed. Thirteen percent of the RDHs had corresponding abnormalities on fluid-attenuated inversion recovery images at the third measurement. Median size of the RDHs was 0.029 mL (interquartile range, 0.013-0.055). RDHs were associated with a multiple infarct pattern (odds ratio, 22.1; 95% confidence interval, 4.5-109.7) and symptomatic carotid stenosis (odds ratio, 5.5; 95% confidence interval, 1.4-21.5). Fifty-nine percent of the patients with RDHs had new additional lesions on follow-up DWI. RDHs were not associated with functional improvement on the National Institutes of Health Stroke Scale score.Conclusions-In this population of mainly minor to moderate stroke patients, complete normalization of MR images was rare. Complete reversal of individual DWI hyperintensities was limited to very small lesions and mostly occurred in embolic stroke patients.Clinical Trial Registration-URL: http://www.clinicaltrials.gov.Unique identifier: NCT00715533. (Stroke. 2013;44:10431048.)